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Issued by the 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 

OCTOBER, 1924 v ■ / >u> ' / 

IT is the purpose of the Provincial Board of Health to assist the Public 
Health Nurses to issue a bulletin which will be a medium for the 
exchange of ideas in connection with their daily work. 

We all profit by experience gained when applying our theoretical 
knowledge to problems that arise and which may be classed as purely 
local. Yet similar conditions in other districts may have to be met, and 
one nurse's experience when told through the bulletin may be of great 
help to others. 

With this object in view the nurses have been asked to send in from 
time to time an account of their trials and tribulations, giving or asking 
for advice. 

Such an interchange of ideas will be of great benefit to all ; not only 
to the nurses, but to the women's organizations, who are so much inter- 
ested in the work and who are the main support of the service. 

We wish the public to understand and appreciate the difficulties 
which the nurses have to contend with and we also wish to have the 
bulletin be a means of educating the public to the fact that a nation can 
only exist and progress on a firm foundation of health. 

We owe such a service to the rising generation. 

Miss Jeffares, Public Health Nurse at Duncan, has kindly edited the 
present issue. 

We have reserved material, from centres not mentioned, for a later 
issue. 



SPEAKING OF RESULTS. 

The actual figures are often beyond our greatest hopes, which is 
another way of saying that the report of my first year's school-work in 
Nanaimo surprises even myself. 

The results from our dental campaign are very gratifying; the 
teachers and the parents, as well as the members of our medical staff, 
have united in making dental work and the routine care of the teeth the 
popular thing. In two classes one-half the pupils have already been to 
the dentist, and in a school of 146 pupils we could only find two boys 
who did not have perfectly clean teeth. 



The children were asked to sign lists in the class-rooms, giving the 
date the}' began and the date they completed dental treatment. Class 
rivalry was stimulated by the promise of a star on the longest list. This 
also gave me an excellent record of the dental work. 

M. J. Woods (Hanaimo). 




COMMUNITY SERVICE. 

Miss McClung, Kelowna, reports that she is a member of a Relief 
Committee, the object of the committee being to raise sufficient money 
to enable Miss McClung to make arrangements for the necessary medical 
and surgical attention required by children whose parents cannot afford 
it. We must ask Miss McClung to let us have a report of the work of 
her committee and the result of their general appeal to the public for 
funds. 



SCHOOL-WORK IN VERNON. 

There are four schools in the town, with about 1,000 children in 
attendance. The majority of the children are suffering from defects 
which have been reported on by the previous nurse, and are still uncor- 
rected. The great difficulty seems to be a financial one. 

I found the Women's Institute very helpful, and through them was 
able to get a dental chair installed in one of the schools, with a view to 
arranging for a dental clinic shortly. 

In visiting the homes of the children, I find the parents are very 
pleased to get any advice with regard to the health of the children I am 
able to give them. 

Jean A. Dunbar (Vernon). 



COLWOOD. 

• In a large district, such as the one in which I am operating as nurse 
in charge of the Esquimalt Rural Nursing Service, the service necessary 
to bring about the desired results of educating the people to a realization 
of the benefits derived from supporting such a service in their midst is 
very varied. 

Apart from the usual aims and objects of a Public Health Nurse, 
which include the dissemination of all information tending to check the 
spread of infectious and contagious diseases, and the inculcation of habits 
of right living amongst the people, child-welfare, etc., social service must 
play a very important part in the daily life of a nurse in charge of such 
a service. 

If all the work accomplished by a Public Health Nurse could be made 
public, there would be no difficulty in obtaining the vote of the people at 
the annual ratepayers' meetings for the extra small assessment towards 

2 ' 



the upkeep of the service in their midst, but much of her work has of 
necessity to be kept confidential, and. therefore much of the benefits of 
the service are known to only the few. 

I will quote one case of many, withholding, of course, names and. 
anything which may lead to identification, whereby the State has been 
saved, potentially, many thousands of dollars ; the State, and thereby the 
people. 

The case deals with the Social Service Branch of the work. I 
learned of a family living away back in the bush, where there were three 
boys who, owing to them living outside the 4-mile limit, had never attended 
school. Accompanied by the vicar of the parish, I went to investigate 
the case. Taking my little car up miles of rough trail with barely room 
at times to pass, we eventually located the place where the family in 
question were living. There we found a shocking condition of things in 
general. The three boys, ages 6, 8, and 10, had not only never been inside 
a school, but were unable to speak properly, owing to the fact that the 
father was almost stone-deaf and the mother on the verge of a mental 
collapse through loneliness and lack of association with her fellow- 
creatures. 

Within two weeks we had the family moved to the village of -, 



and very soon after that had collected sufficient clothing for the boys to 
attend the school there. This was some months ago, and the boys are 
now doing well at their studies and show fine promise, and the mother, 
though still suffering more or less from her terrible experience of lone- 
liness in the bush, shows great improvement, and no reason at all why 
she should not become a normal healthy woman. The father, a good 
workman, but severely handicapped by his extreme deafness, will have 
the chance to become a useful self-supporting citizen, as I succeeded in 
interesting the local Women's Institute and the Nursing Association to 
the extent of procuring an ear-trumpet for him. 

That is only one case from one portion of the district; but it will 
serve to show how necessary it is for a Public Health Nurse, when in 
charge of a district, to give and have a wide view of the opportunities of 
service, and for the people to realize this service and support it liberally, 
and thereby save themselves increased taxation in the future. It will 
not require a very vivid imagination to realize what a burden such a 
family would have become to the State eventually had they been left to 
their own devices. 

With regard to the progress of the Nursing and Public Health Branch 
of the work, we have by. dint of perseverance, and with the co-operation 
of the Public Health Department and the Saanich Health Centre, 
to whom we are indebted for the loan of a dental chair, established a 
dental clinic for children of school age and under — a service which has 
proved itself to be of undeniable benefit and which is greatly appreciated 
by the parents. We held our first clinic during the Easter holidays and 
are continuing the work to completion during the midsummer vacation. 
There is no better foundation for health than in a clean mouth, with 

3 



well-preserved teeth that will masticate the food required to build up a 
healthy child, and ensure a good digestion and assimilation of the same. 

Of my pre-natal work, first-aid work, etc., I need say very little, but 
it is very gratifying to note the growing confidence with which mothers 
will appeal to the nurse for advice regarding the slight ailments of their 
children, and the welcome extended when making those numerous " home " 
visits, which mean so little to the casual observer when reading of the 
number of " home " visits made in the monthly report, but which mean 
so much to the nurse and to the parents and to the future realization 
of the achievement of the aims and objects of the public-health move- 
ment. 

I have Girls' Health Clubs established in several of my districts, 
and hope before very long to have Boys' Health Clubs established 'as 
successfully. My dreams for the future include a real health centre, 
where boys and girls and men and women and babies will come to 
" play " and learn to be healthy; not come because they are sick, but 
come to learn how to keep well ; space will not permit of detailed descrip- 
tions of my " dream health centre," but in time I hope to achieve my 
object. A Fublic Health Nurse's object and that of a Nursing Service 
should be that of promoting public health; not merely the attending of 
sick people at so much per visit, but by giving advice privately, and 
in public-health talks show them how to keep well so that they won't 
require the services of the nurse for sickness, but be glad to pay for her 
upkeep in their midst because they recognize their need of her. 

I have a splendid committee to work with, one whose motto is 
" progress," for which I am very thankful, and who are, one and all, 
in absolute sympathy with the movement and who encourage and do not 
hinder. 

Helen Kelly. 



DUNCAN. 

Cowichan Lake School Fair. 

I had accepted an invitation to attend the School Fair at Cowichan 
Lake, our most rural school, about 20 miles from' the Health Centre head- 
quarters, and present the prizes for the Health-book Competition, which 
were given by the Provincial Board of Health. Cowichan Lake School 
is in the centre of a logging communit} 7 and most of the children come 
from the different camps. 

On arrival at the school we found the judges were busy in the 
school-house with the exhibits, and sports in progress on the grounds; a 
group of about forty parents being accommodated on roughly put-up 
benches or on the desks from the school-house. 

In the school-house the different exhibits were arranged attractively, 
our interest, of course, being centred on the " Health Books." Last 
February it had been suggested to the teacher that, if she cared to take 
the matter up, a prize would be given for the best essay, poster, or book 
on any health toi>ic taken up by the School Nurse during the term. 

4 



About eighteen books and several posters were sent in competition; some 
of them were a great surprise. The majority of the books were illus- 
trated with cut-outs, while some had little pencil or water-colour sketches, 
all of them being made to look as much like a book purchased in a shop 
as possible. One clever little book on " Milk " had an amiable-looking 
cow on the front cover and a very tiny milk-bottle in the centre of the 
back cover. 

After the sports had been run off and the judges had completed their 
task, the pupils put on a little health playlet, in which there was paraded 
before a little, pale, thin " City Boy " all the good things he could procure 
more easily by living in the country. The children were dressed to look 
the part of the article they represented ; for instance, " Egg " was a tiny 
golden-haired girl, carried in a large basket covered with white crepe 
paper. When all the " Good Things " were arranged around the little 
boy and he was considering their real value, in walked a procession of 
his old-time " Enemies," headed by a large " Coffee-pot," and followed 
closely by " Pie " and " Candy." It was not very long, however, before 
the superior strength of " Milk " and his faithful supporters was felt, 
the " Enemies " chased afar off, and thin, little " City Boy " left to his 
new friends. 

I. M. Jeff ares (Duncan). 

Good-health Competitions in Rural Schools. 

Realizing that it was possible to arouse interest in health-teaching 
in rural schools by way of a good-health competition, we decided to put 
on this year a competition among all the rural schools in our district. 
The rules of the competition are simple and as follows : — 

Between the rural schools visited by the Public Health Nurses from 
the Health Centre, Duncan, this year we are going to have the most won- 
derful competition for the best HEALTH POSTER, HEALTH BOOK, 
and for the best ESSAY on any HEALTH TOPIC. 

There are going to be SIX PRIZES offered, as follows : — . 
Prize for the BEST POSTER made by a girl. 
Prize for the BEST POSTER made by a boy. 
Prize for the BEST HEALTH BOOK made by a girl. 
Prize for the BEST HEALTH BOOK made by a boy. 
Prize for the BEST ESSAY written by a girl. 
Prize for the BEST ESSAY written by a boy. 
The poster is to illustrate a " Health Talk " given by the nurse. The 
essay may be upon any " Health Topic " taken up by the nurse during the 
school term. The " Health Book " must tell and illustrate the story of 
" Good Health." 

Special Prizes. — A special prize will be given in each school for the 
BEST POSTER, HEALTH BOOK, OR ESSAY, the age and school 
standing of the competitor to be taken into consideration by the judges. 
Competition to close May 31st, 1925. 

The Provincial Board of Health has kindly offered to see that we 
have prizes and we are looking forward to a great many entries. 

5 



Iii order to conduct the competition with as little confusion as pos- 
sible, we drew up the outline of " Health Talks," given below, for the year, 
so that all the children will receive the same instruction and have an 
equal opportunity to send in the best poster, health book, or essay. 

Month. Topic. Story. 

Sept Cleanliness, fresh air, and sunshine The Pig Brother. 

Oct Proper food and drink The Milk-bottle. 

Nov ....Teeth ...Old Grouchynian Tooth- 
ache. 

Dec. Proper clothing, posture, and exercise. .The Crooked Man. 

Jan School ventilation and common cold Mary had a Little Cold. 

Feb Germ-life — common cold and sore 

throat Billy's Pal. 

March The need of green vegetables and fruit, 

also neatness and cheerfulness The Two Houses. 

April Talk on annual physical examination, 

the reason and why defects found 

should be corrected, leading up, 

especially with interest to the older 

children, to the need of a healthy 

race physically, mentally, and mor- 

ally in Canada. 

May Flies, home and school sanitation ....The Diaiw of the Fly. 

June General review and presentation of 

competition prizes. : 

I. M. Jeffares (Duncan). 



PEP SON AT, ITEMS. 

When a nurse is making a change from one district to another, it is 
very pleasant to be able to carry away the knowledge that the people of 
the district appreciate your work among them, not only professionally, 
but from the community standpoint as well. Such must be the knowledge 
of Miss Gawley when she looks back on July last, when the people 
of the Malakwa District met together to make her a presentation, and to 
say " Farewell " to her on the eve of her departure. 

-if -a- ■& -if -if 

Miss Ada Benvie has resigned her position on the staff of the 
Cowichan Health Centre, as she finds it is necessary for her to remain 
with her mother, who is ill at her home in Nova Scotia. 



Miss E. Naden, B.Sc. (Nursing), IT. B.C. '24, has been appointed to 
Cowichan Health Centre. 

■X- * * * * 

Miss E. N. Bodenham has left Keremeos for the " Old Country," 
where she expects to remain indefinitely. 

6 



CONVENTION NOTES. 

During the past summer there have been .several conventions held 
in the East of interest to Fublic Health workers, and being fortunate 
enough to obtain a copj^ of notes taken by a Public Health Nurse attend- 
ing three of the conventions, I thought perhaps some of the other nurses 
might enjoy reading* them also, as it is surely interesting for us to have 
an idea of what the leaders of our profession are thinking and of the 
work that is being carried on elsewhere. 

At the Biennial National Nursing Convention held in Detroit in 
June, Dr. Lockwood, of the Pasadena Hospital, spoke on " The Pole of 
the Physician in the Education of the Nurse," after which there was a 
very heated discussion, at which it was admitted that more and more the 
education of the nurse should be turned over to the nurse. Dr. Lock- 
wood said that medical men were too busy to properly prepare their 
lectures, and consequently the lectures were often either too advanced 
and technical or too elementary to be of much value. He admitted that 
man} T doctors felt that the pupils should receive onty such teaching as 
they chose to give them, but he felt that the nurses themselves should be 
equipped to give most of the teaching, and he felt sure that the doctors 
would very soon realize the value of such a step and would be glad to 
relinquish the teaching to the nursing profession. 



In giving an address on " Communicable Disease " at a general ses- 
sion, Dr. Chas. Emerson, Dean, Indiana University School of Medicine, 
said he thought it was the duty of every Public Health Nurse to teach on 
every possible occasion to individuals and to groups the value of serums, 
vaccines, and antitoxins as preventive measures against communicable 
disease. He also felt that, unless the nurse herself was a firm believer 
in all preventive measures, she should not pretend to be teaching pre- 
ventive medicine as a Public Health Nurse. He felt that a nurse who 
could not believe thoroughly and implicitly in preventive measures that 
had proved to be successful should find some oilier line of work. 

•X- -X- * -X- * 

At the Child Welfare Section of the National Organization of Public 
Health Nursing, the general thought of the meeting was that in most 
cases too little attention was being paid to the pre-school child. While 
realizing that at present the school-child needed a great deal of care and 
attention, it was felt that most organizations should lay more stress on 
the necessity of allowing more time for work with the pre-school, and 
that much of the health-teaching in the schools would need to be given 
by the teachers, thus leaving the nurse free for more intensive pre-natal 
and pre-school work. 

The question of continued visits to mothers who failed to co-operate 
with baby clinics and welfare organizations came in for lengthy dis- 
cussion, some of the nurses maintaining that after a period of two or 
three months such mothers should be dropped and the nurses' time and 
energy given to those willing to co-operate. Finally, however, the meeting 

7 



decided that this was not the wisest course, and that the mothers who 
would not co-operate were those who were most in need of education, 
and that there should be no limit to the time of carrying such patients. 
It was also suggested that a change of nurses visiting a particularly non- 
co-operative individual might bring about the desired results, as very 
few of us in this world can deal satisfactorily with every question. 

•K -X- * * -X- 

At another meeting, Dr. Haven Emerson, speaking on " Meeting the 
Demands for Community Health Work," emphasized the thought that 
community health is, after all, primarily an individual problem; that 
we must seek to educate people to their responsibilities towards main- 
taining the health of themselves and their children and of guarding 
against communicable disease by the preventive measures that are now 
available. When this is done, community health will be cared for to a 
great extent by the people themselves. Dr. Emerson felt that this should 
be the end towards which we should all strive, to make people realize and 
admit their individual responsibility for the health of their community. 

Miss Crandall, of the American Child Health Association, took a 
view almost opposed to Dr. Emerson, and laid the responsibility for the 
community health almost entirely on the State or Federal Government. 
She advocated communistic methods of obtaining medical and hospital 
aid and of pensions, etc., for old age, sickness, unemployment, etc. She 
did not feel that the individual was primarily the one to undertake the 
work of raising standards of community health. 

Mr. William J. Norton, Secretary of Detroit Community Fund, said 
that so often Public Health Nurses and doctors were so interested and 
enthusiastic about their work that very often they failed to realize that 
the public at large did not understand clearly just what they were trying 
to accomplish with the monej' they asked for. 

He said that we should remember that, after all, it is the lay people 
who provide the money, and we should take greater care to see that they 
understand just what we are trying to accomplish before we ask for 
money, and we should invite their co-operation in the spending of their 
monev more often than we do. 



Dr. Dixon, Director of V.D. Clinics, Detroit, spoke on " Milestones 
in Progress of Social Hygiene from a Medical Standpoint." He empha- 
sized the fact that venereal disease can be both cheaply and satisfac- 
torily treated if we can only educate people to the necessity. 

He said that in his opinion sex education should be given in the 
home, but deplored the fact that so few people have a vocabulary which 
is at all adequate for such teaching. Dr. Dixon said he made it a practice 
to ask the mothers and fathers who came to him for some considerable 
period just what they knew about such matters and what they could 
tell their children, and he said very few of them had words which could 
be used without embarrassment. Dr. Dixon said he felt it was the duty 
of every physician to teach parents in simple dignified English what 

8 






they hand on to their children, and maintained that such teaching could 
y never be undertaken until the people were provided with a vocabulary of 
simple dignified words. 

•x- ->:- * * * 

Efforts to prevent crime among foreigners should be along lines of 
showing them the opportunities the new land has in store rather than 
endeavouring to make them forget their own national traditions and 
ideas. 

The Employment Service in Canada was reviewed by Professor Jack- 
son, Toronto University. In 1923 about 377,000, or about one-eighth of 
the working population of Canada, obtained work through this service. 
Stabilization of employment by public expenditure was complicated by 
the fact that the Federal Government does not consider unemployment 
primarily its problem, although willing to help the municipalities to a 
certain extent. Up to the present, Professor Jackson said, the method 
has been haphazard and in future must be considered on broader lines. 



Conference on Social Work, Toronto, June 25th to July 2nd. 

At a luncheon of police-women, Mrs. Wooley, of the Merrill-Palmer 
School, Detroit, spoke on " Pre-delinquency," emphasizing the fact that a 
great many of the lasting impressions are recorded on a child's mind 
before the age of 5 years. She is convinced that the seeds which later 
bring a harvest of disgrace are sown very early in life and are planted 
sometimes by parents, who are not evil-minded but merely injudicious, 
and are ignorant of methods of wisely training children. She believes 
that back of every crime lies a mistake in training and that the innocent 
beginning of many an evil habit lies in mistaken training methods of 
parents. 

The telling of diplomatic lies was strongly denounced. Many parents 
consider it an easy way of dealing with children, but it is unsafe, par- 
ticularly in dealing with the ages of 3 and 4, when the imagination is 
apt to run riot. 



v/ 



Mr. K. C. McLeod, of Edmonton, was the principal speaker at a 
meeting when the problem of the underdeveloped child was discussed. 
He was of the opinion that the time had come for drastic measures. He 
thought that many of the children could be socialized and if put in the 
right kind of home could be taught certain routine duties. Those inca- 
pable of being taught should, in his opinion, be chloroformed. Mr. McLeod 
thought that a country which was already overburdened with taxation 
should not be asked to provide expensive institutional care for such 
cases. He also maintained that all definitely feeble-minded persons 
should be sterilized, thus cutting off at the source the supply of feeble- 
minded children. 

Two resolutions were adopted at this meeting : — 

(1.) To the effect that the association strongly disapproves of any 
newspaper publishing any details of any criminal offence by children 

9 



before such a time as their eases have been disposed of by the Juvenile 
Court; the theory being that the notoriety of any case injures the child 
and adds to the possibility of future delinquency. 

(2.) To advise the various Provincial Governments that they should 
harmonize and co-ordinate as far as possible those branches of the public 
service dealing with the supervision and inspection of children in foster 
homes, and the inspection conducted by the school, health, and other 
organizations, to avoid undue multiplication of expenses. 

Dr. Bernstein described the development of the last thirtv* years in 
the care and education of the feeble-minded as carried out by the institu- 
tion at Koine, N.Y. All of the inmates (as far as possible) are trained 
for some manual work. On some of the farms where the bovs are taught 
they are entirely self-supporting, and the simple environment of the farm 
is the best possible for them. Considerable success has been attained in 
starting some homes for girls in small cities where they can go out and 
perform domestic duties during the day and return to the home at night. 

* * » * * 

Dr. Chas. Johnson was another speaker at the same meeting. He 
deplored the feeling of antagonism which had arisen between many public 
and private agencies. He urged all social workers to go back with the 
resolve to educate legislators out of the belief that posts of responsibility 
in welfare-work should be regarded as " political plums.-' 

■K- **'- v!- 4f -a- 

At the meeting of the Immigration Session, Dr. Barnes in his address 
said the immigrant should be taught English, but should also use their 
mother-tongue, and the best customs of their own land should be main- 
tained and blended with our customs. 



VICTORIA, B.C. : 
Printed by Ciiari.es F. Baxfield, Printer to the King's Most Excellent Majesty. 

1024. 



1M-1024-7638 



10 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 APRIL, 1925 No. 2 

THE reception accorded the first issue of our get-together bulletin was 
most gratifying, and whilst the material at hand does not enable us 
to promise an issue on specific dates, yet we are assured of such an 
interest that publication will be continued. 

The present issue is limed for distribution at the next meeting of 
the Refresher Course to be held at the University in Vancouver, April 
loth to 18th. 

The experience gained at last year's course has enabled us to enlarge 
the programme, special attention being given to the Public Health Nurs- 
ing Service, and under the able direction of Miss Ethel Johns, Depart- 
ment of Nursing and Health, University of British Columbia, we are 
promised a most profitable and enjoyable time. 

The gradual hut solid growth of the Public Health Nursing Service 
in British Columbia proves its worth, and the Department feels that this 
progress is due largely to the efforts of the nurses. 

The success obtained in any locality rests primarily on the persis- 
tence and personality of the nurse. Thai our nurses have succeeded in 
the face of many difficulties is shown by the results. 

The letters received in (he Department from many who formerly 
were severe critics is the best evidence that the nurse, unaided, has 
overcome and turned active opposition into approval not only of the work, 
but of the nurse herself. 

The change in public opinion in reference to our work may be 
visualized by looking at (he change in baby's dresses, so well shown in 
the pictures in this number furnished by Miss McClung. 

The Department would suggesl thai (he question of books on nursing 
lie discussed at the Vancouver meeting, especially in regard to those that 
might he used for reference. 

May we take this opportunity of expressing the Department's appre- 
ciation of the work of the nurses and to say that if s^tmis to us that the 
nurses in the Public Health Service believe 1 that the best reward for all 
endeavour is " work well done." 

We are again in debt to Miss Jeffares, of Duncan, for her work as 
Editor. 



SAAjNIOH. 

As a member-of the Saanich War Memorial Health Centre my experi- 
ence in public-health nursing has been con lined to rural work, and 1 am 
in favour of the generalized plan. 

There are many reasons why the generalized plan is the only one 
for rural communities. First, there is the question of expense. We 
know llial the people find it quite a burden at times to support a nurse; 
in fact, in many districts, even when generously assisted by grants from 
the Provincial Board of Health, a portion of the people feel it is too 
great a burden. So one can readily see how utterly impossible it would 
he to support several nurses doing specialized public-health work. 

Secondly, in most rural places, with the exception of the more 
thickly populated, such as Saanich and Cowiehan, there is sufficient work 
for one nurse only. 

Thirdly, it affords greater satisfaction to the nurse herself to know 
that she can he of service to the entire family in bedside nursing, school- 
work, T.I)., and child-welfare visiting, as well as social-service worker in 
time of need. 

Fourthly, those who have lived more or less isolated lives are natu- 
rally quite reticent, and are more likely to confide in one nurse than in 
several. 

During the past three years the Public Health Nursing Service as 
directed from the Saanich Memorial Health Centre lias grown to such an 
extent that the nursing stall' now consists of Nurse Superintendent, two 
District Nurses, and one School Nurse. Our district is a large one, 
covering an area of 55 square miles, with a population of 12,000, of which 
1,800 are school-children. 

In order that the work can he systematized, a nurse is in charge of 
tin 1 prenatal and bedside nursing, another the school-work, and the third 
the child-welfare work. Do not mistake this for specialized work. For 
example, I am the second District Nurse in charge of the child-welfare 
work. I usually begin my day in school-work, transporting the School 
Nurse and 1km- equipment to her allotted school, gathering together the 
children who have appointments with the demist and bringing them to 
the clinic. If there is a case of communicable disease in a school, I 
assist by inspecting the children in the class-room daily for ten days, 
and follow up any absentees with a home school visit. Then, again, the 
stork has been exceptionally busy and the other District Nurse requires 

relief. A call comes from the Municipal Hall, " Mr. is reported 

to be in want; please investigate." Now I become the social-service 
worker. So, too. the other nurses have similar experiences, and we 
conduct our service under the generalized plan. 

The Child-welfare Nurse endeavours each month to visit every infant 
under 2 years of age and every pre-school age child in the district. At 
present we have about 600 pre-schoo! age children under our supervision. 

Each month a list of births in Saanich is forwarded to the Centre 
from the Vital Statistics Department. They art 1 visited as early as pos- 
sible, and almost without exception the mother is glad to set 1 the nurse 







03 
01 

:*0 



s? 



and seek advice from her. We tell the mother (hat if she is worried 
about the baby to send for us and we will be glad to assist in any way. 
These visits are recorded and kepi on file in the Centre. 

We always introduce the subjecl of the well-baby clinics, discuss {he 
value of them, and invite the mother and baby to attend. Last year- 
several never missed a clinic, and we have mothers who cannot praise 
too highly the work of the clinics, for bad it not been for such and the 
follow-up work by the nurse, some of them undoubtedly would not have 
their babies to-day. 

We help the mothers in regard to diet both for herself and family. 
Encourage breast-feeding and discourage canned foods at all times. 

As the child grows older, we talk about the importance of clean, 
healthy teeth; show the rigid kind of toothbrush (the Untax); advise 
consulting the dentist every six months. We look at the throat and 
tonsils and if swollen or pitted advise consulting the family physician. 

We are proud of the fact that the first pre-school clinic in British 
Columbia was held in Saanich. We believe thai if we supervise the child 
until he is 6 years of age he will (Miter school in good health and will be 
able to get the most oui of his school-life, because he will not be handi- 
capped by infected tonsils or decayed teeth. 

Florence L. Fullerton, R.N. 



A DENTAL PLAYLET. 

On December lSth I was invited to attend the Christmas concert 
given by the pupils of the Yovke Road School in Duncan. This is a 
one-roomed school and all the children are in the third grade. 

To me the most interesting part of the programme, composed of 
songs, recitations, and short playlets, was the little play entitled "The 
Lad Molar." This playlet stresses the reason why the "Six-year-old 
Molar" should be cared for, and makes the reasons (dear and interesting 
to the children, and to the parents as well. A large face was improvised 
and the children's heads fitted with white cardboard representing the 
different teeth. 

The characters were: The Little Old Woman who lived in a Cave; 
Jack Central Incisor; Jill Lateral Incisor; Jackie Horner Ouspit; First 
Baby Molar; Second Babv Molar (the Bad One); Six-vear-old Molar; 
Bicuspid; Mr. Toothbrush; Mr. Dentist. 

The Bad Molar has persistently refused to allow Mr. Toothbrush to 
scrub him, and consequently while the others are enjoying a game he is 
afflicted with severe pain. Mr. Dentist can do nothing bu1 pull him out. 
Six-year-old Molar being weak leans over toward Firs! Baby Molar for 
support. Bicuspid then tries to grow into place, but there is no room, 
so he must come in out of line, thus spoiling (he usefulness and good 
appearance of all the permanent teeth. 

The children were keenly interested in preparing the playlet and 
are now giving more attention to the care of their teeth. 

E. Naden, R.N. 



PIONEER NURSING ON VANCOUVER ISLAND. 

Sayward is situated on the cast coasl of Vancouver Island, 180 miles 
from Victoria and 135 miles from Vancouver. Coming to Sayward in 
the month of August, 1020, when transportation was very bad, I found 
the bridge across the Salmon River was out, and it was necessary to 
use a rickety foot-bridge built by the settlers or cross by the ferry when 
the river was low. There have been many improvements, however; we 
now have a line new suspension bridge, two others have been repaired, 
and I believe (here is a new wharf under construction. 

Shortly after my arrival some of the progressive settlers, hearing I 
was a nurse, corresponded with the Provincial Board of Health, asking 
for a School Nurse, and I was given (he appointment on part time. 

I was visiting a neighbour one day. when (wo young girls came up 
and asked if I would go and see a yonng woman who was ill at a cam]) 
about S miles distant. Without further delay I left my two girls with 
the neighbour and started off. About a mile down the road 1 met the 
mail-carrier with a note, explaining (hat (he woman I was on the way 
to see was expecting her baby and could not get out to Rock Ray Hospital, 
as she had planned. I hurriedly procured as much in the way of sup- 
plies as possible and continued my journey. On arrival at the home I 
set to work, anil by 2 in (he morning the first baby of the family had 
arrived, a fine healthy little girl. Newer shall 1 forget my anxiety and 
fear (hat everything would no! be normal. 

A lad cut his foot the other day with an axe and his father came 
running for me. The eul was long, and after bathing if well with lysol 
solution, removing worsted and other foreign particles, if was necessary 
for me to put in two stitches. The wound healed well and the boy was 
soon walking around. 

I find (here is a lark of understanding and perhaps of appreciation 
of what a nurse can actually do. and what I am attempting to do. in 
several cases, I am grateful to say, some of the mosl antagonistic members 
of the districi have been glad to send for me in time of need. 

It is difficult working alone and not having the advice and assistance 
of a doctor. 

School-work.— 1 have (wo schools about 5 miles apart with a total 
attendance of twenty-three 1 children. After my appointment as School 
Nurse 1 had considerable difficulty with the problem of pediculosis. 
Some of tin 1 parents were indignant that I should examine their children. 
I am glad to say that through constant supervision and treatment 
unclean heads are past history in Sayward. 

Two years ago, with the assistance of (he Provincial Board of Health, 
it was possible to ge( a dentisi to visit (he schools. He slaved ten days 
and attended to all (he necessary work. This year, I believe, he is coming 
in for trout-fishing and i am hoping will be able to attend to the necessary 
denial work at the same lime. 

Last year an optician came in and several patients, including two 
school-children, received treatment. 

5 




£ 



H 



The teacher in each school has a first-aid box and is able when 
necessary to render aid. They also provide a hot drink for the children 
who bring their lunch to school. 

Through co-operation with the Women's Institute we have had a 
filter put in the lower school, also individual cups and towels. 

M. Walls. 

KELOWNA FALL FAIR. 

We had our first public-health exhibit at the Kelowna Fall Fair in 
September, 1923, just ten days after my arrival. The time had been 
very short for the necessary preparation and it was only through the 
co-operation of the local merchants, who kindly loaned nie different 
articles to supplement the equipment already in use, that I was able to 
have an exhibit at all. Considerable interest was shown, sufficient to 
encourage me to greater efforts for the 1024 Fair. 

Early in the year I made sure of a larger space in a conspicuous 
corner. Aside from (he articles 1 was again able to borrow from the 
merchants of the town, I made and used others to substitute when it 
came to a question of money in the home. For instance, the making of 
a baby's bed out of a clothes-basket and the use of a plate for holding 
the articles for baby's bath. 

One of the merchants gave me several end rolls of wall-paper, which, 
being of a blue-and-white pattern, showed to advantage the baby-clothing 
hung up in that section of the exhibit. 

Comparisons between tlie " old system " and the " new system " were 
carried out through the entire exhibit. A great deal of interest was 
shown in the old-fashioned baby-clothes as compared with the modern, 
and many were interested in the cradle, but preferred the kiddie-coop 
and cot, while Peter, the demonstration doll, and who occupied the kiddie- 
coop, was desired by the children, many of them coming again and again 
to see him. 

The placing of placards on the different exhibits, as, for instance, 
"Baby should sleep alone," assisted me greatly and made it possible 
for the people to ask more intelligent questions. 

Almost as many men as women came to see the exhibit, and remarks 
such as " Very enterprising"; " This exhibit is not only good to look at, 
but means something," were a few of those overheard. 

Mrs. I). W. Sutherland was my only assistant in getting the exhibit 
ready. 

M. R. McClung, K.N. 



PROBLEMS OF THE PUBLIC HEALTH NURSE. 

The first and, I might say, one of the foremost problems that a 
Public Health Nurse has to face is, strange though it may seem, her 
committee. A committee in charge of a Public Health Nursing Associa- 
tion is composed usually of public-spirited men and women, who are 
elected bv the residents of the district in which the association operates. 

7 



These men and women as a general rule have the true interests of the 
association and work at heart, bul often they lack the necessary knowl- 
edge and education in rural nursing, which makes it difficult at times for 
the nurse. They arc anxious to be able to present a good report at the 
end of the year to the people who elected them toad in their interests, and 
for this reason are apt to study the dollars and cents before service. 

True, the dollars and cents must be looked after, and it is certainly 
up to the committee to see that the money is spent economically and 
without waste, as far as is consistent with good service ; and sometimes 
one or two of the overzealous will quibble over trifles which would mean 
an almost negligible saving to the funds of the association, and at Ihe 
same time do more harm than good with the general public. 

They fail to realize sometimes that the nurse in charge has, as a rule, 
had many years' experience in this particular line of work in different 
parts of the country (I am speaking, of course, of the thoroughly experi- 
enced nurse), and that her judgmenl is based upon Ihe study of the 
people with whom she has to deal and the conditions under which she 
has to work, and that that judgmenl is usually sound and reliable. 

1 am nol suggesting that the nurse should be in a position to dictate 
to her committee — far from it ; she is usually quite satisfied to leave the 
business management in their hands, bul in some cases, when a question 
arises regarding some little point in the administration of the service, 
it would be well if Ihe committee were to ask Ihe nurse's advice before 
coming to any definite derision. .Much trifling comment and criticism 
would be avoided if this practice was adopted. 

Suggestions for overcoming Difficulties and solving these Problems.— 
I would suggest, by a course of lectures or talks by some of those in 
authority in public health work, and under the direction of the Provincial 
Board of Health, at the meetings of the Committee or Council, to educate 
the members regarding the true, fundamental principle of a public-health 
service; to bring to their notice lice vast difference between a public-health 
service and an ordinary professional nursing service, or other professional- 
service. Their attention .should be drawn to the fact that the people who 
are supporting the service by voluntary taxation have a right to consult 
the nurse on small matters, by phone or personal calls, should they so 
desire, without being called upon to pay the nursing fee, as they would 
if her actual professional services were required. 

The result of these talks would be an enlightened Council or Com- 
mittee, and they, then, in turn would give careful consideration to the 
election of their Executive Committee, and appoint men and women with 
a view broad enough to overlook petty trifles and constructive enough 
to accept suggestions offered for the upbuilding of ihe service, even 
though such suggestions may not happen to just coincide with their 
immediate views. 

II. Kelly, K.N. 



KEEPING OUT OF RUTS. 
By Dr. C. E. A. Winslow. 

The point that seems to me of major importance is the necessity of 
keeping your sense of your work vital, not getting into a rut, not taking 
the day's round as a day's round of so many places to visit, so many tasks 
to perform, but cultivating awareness of the possibilities and of the pur- 
pose of the work of your organization^ Do you remember the story of the 
ship off the north-east coast of South America, on which the drinking- 
water had given out? The crew were almost at the point of dying from 
thirst, when they finally saw a steamer approaching and hoisted a signal 
of distress. When the steamer came nearer they signalled they were in 
need of water. The steamer ran up the reply, ,b Let down a bucket where 
you are." The suffering crew thought they were being mocked; but 
after the signal was repeated several times, at last they did let down a 
bucket and found the water was fresh. They were in the mouth of the 
Amazon River, where it flows in all its freshness far out into the sea. 
We are constantly looking for inspiration and encouragement, for big 
and stirring things outside. The needed inspiration can be found in our 
daily work if we realize to the full what the public-health campaign 
actually means and what if is accomplishing. 

Remember, too, that you are never alone in the performance of the 
great tasks to which you are dedicated. The nurse has a tradition; she 
stands for something. 

She is a member of an organization; but she is more than a member 
of her organization. She is the link between the public-health science 
and the community. I was tempted to put the name of " Louis Pasteur " 
on the chart instead of " Public-health Science," because you are carrying 
the message that Pasteur first discovered in that dingy little laboratory 
in the Ecole Normale, and that scientific men all over the world are still 
working out, down to Dochex and his scarlet-fever serum in New York 
City. The wonderful struggle for the betterment of existence through 
' the healing touch of science in your hands. You are the channel through 
which the stream flows to the people. You are part of the great sweep of 
human progress toward a safe and richer life for all mankind. 



PUBLIC HEALTH NURSING IX NANAIMO. 

Nanaimo is very happily situated for public-health work; it is not 
too large, easy to get about in, with very little unemployment. A small 
monthly fee of about $1 provides the service of a doctor for all the 
employees of the Western Fuel Company and their families. This com- 
pany's medical service does not include dentistry or the services of a 
specialist for eye examination. It does, however, provide the service of 
a doctor for adenoid and tonsil operations, the people paying a small fee 
for the use of the operating-room and a charge for the day or so they 
spend in hospital, which usually amounts to about |5 or $10. 

9 



Thinking over 1 lie work here, our first impressions were the same — 
namelv, how much educational work was needed before any results could 
he expected, other than those obtained from individual instruction. 

The educational work has gone steadily forward in the schools since 
September, 1923, and in the Nursing Service since May, 1924 Much has 
been accomplished through the distribution of literature, talks in the 
class-rooms, talks at Service Clubs, etc., but we still feel the need of 
" convincing" many of the people and have them assume personal respon- 
sibility for themselves and their children. 

In the schools, for example, small cuts and abrasions often become 
infected unless the child conies daily to the School Medical Office for 
dressing. Soap, hot water, and clean cotton are all that is necessary 
if treated at the time of injury, and once a day for a short period. 

Our greatest advance in the schools has been in the daily care of the 
teeth. In December, 1923, the dentists made a survey of some hundreds 
of the pupils and their report convinced the people beyond a doubt that 
the teeth need daily care at home, as well as regular examination by the 
dentist. 

The regular work in the school has been interrupted by an epidemic 
of measles and of impetigo in 1923 and 1!)24, and by scarlet fever in 1024 
and 1925. The epidemic gave us an opportunity to instruct in a very 
practical manner the source of infection, the transmission and the pre- 
vention of disease. That the latter is really a matter of individual 
responsibility was brought home to the pupils as each new case developed. 

The Nursing Service 1 includes the usual work, obstetrical and other 
bedside nursing leaving little or no time for child-welfare work. The 
results of the prenatal service is very satisfactory, co-operation with the 
doctors making it possible to report to them any unfavourable symptoms 
noted. 

The teachers appreciate the literature we have for distribution very 
much, and requests have come to us for literature from teachers outside 
of the city, where as yet there is no Nursing Service. 

We cannot speak too highly of the interest and kindly understanding 
displayed by our Boards, an interest that never fails, even though we 
sometimes feel that the results are slow. The doctors, dentists, the 
different Service Clubs and all the societies interested in the welfare of 
the public support our work, and thus we feel that the future holds great 
possibilities for the results of the last years' educational and practical 
work. 

A. A. Lee. 
M. J. Woods. 



KAMLOOPS. 



The physical examinations conducted in the Kamloops schools last 
winter revealed, as usual, the glaring need for dental attention. Some- 
thing should be done, and that right early. When approached upon the 

matter the dentists willingly agreed to conduct a survey among the school- 

10 



children. They spent on an average of probably three or four hours each, 
and the statistics thus obtained were startling; 87 per cent, of the 
children showed dental defects, and of these 66 per cent, had need of 
attention in their permanent teeth. 

On completion of the survey I was informed that the School Board 
were having a meeting in a few days to make up the estimates for the 
year. This left little time to prepare a comprehensive report which at 
the same time would prove convincing. However, after its presentation 
to the School Board, that body considered a school dental clinic so neces- 
sary, both from the health and from the economic standpoint, they 
unanimously appropriated funds to provide equipment for a permanent 
dental clinic ; also sufficient funds to guarantee a dentist's salary for the 
first year. 

Unfortunately for the welfare of the clinic, the School Board's 
estimates far exceeded those of previous years, with the result that the 
City Council were thoroughly opposed to the extra expense that a clinic 
would involve. For the following three weeks "Dental Clinic" was 
freely discussed. It became the favourite topic of conversation on the 
streets and a number of letters were published in the local paper " Re 
Dental Clinic." The proposed plan did not lack advertising and parents, 
I believe, were strongly in favour of its being carried out. Unfortunately 
a few prominent taxpayers strenuously fought the plan by means of public 
letters. These letters revealed the fact that there were a number of 
misconceptions regarding dental clinics in general. There was much talk 
of a ''free" clinic. Strange rumours of mollycoddling were cast abroad 
and great stress was laid on the big burden the taxpayers would have 
to assume yearly. And this in face of the fact that full explanation was 
given in the report, which in turn was sent to press by the School Board. 

A combined meeting of the Council and School Board was held to 
consider the estimates. The Council, feeling convinced they were voicing 
public opinion, brought the strongest pressure to bear against the School 
Board's action in endorsing the establishment of a clinic. Although the 
latter had it in their power to stand by their first intention (funds for 
a school dental clinic being, according to school law, an ordinary expendi- 
ture), the opposition was so strong they decided to cut down on the 
equipment, but still retained the amount for the dentist's salary on their 
estimates. 

The only alternative now was to find a dentist who would do the 
work in his office; or, failing that, each man take a share of the work. 
This, as Dr. Young suggested, would create favourable public opinion 
and be a stepping-stone to the establishment of a proper dental clinic. 
Great disappointment was felt when the dentists could not see their way 
clear to carry out the suggestion, and now plans for a dental clinic must 
be shelved until the time is ripe to bring them to light again. 

In looking back upon the efforts of the past few weeks, it is given 
one to see where proceedings might have been different and to advantage. 
Nothing big is accomplished in a day. The vast majority of people are 
conservative and tight stubbornly against the invasion of a new idea, 

11 



especially when they are confronted with it suddenly. It looks strange 
and, because strange, alarming. But warn them of its approach; talk 
it over with them; point out its fine qualities; soften its alarming 
features with reason; then when the stranger arrives the door will be 
thrown wide and the idea, now no longer new, will be welcomed as an 
honoured guest. 

It was the intention to adopt this method with the clinic idea; to 
go about quietly with a view to making people anxious to accept the new 
institution by making them realize how worth while the results would be. 
Unfortunately, or in this case it may be Fortunately, the School Hoard 
meeting to consider estimates was held at the time and the matter was 
rushed to a climax, with a view to saving time. We shall not regret 
what lias taken place, for " clinic ' lias been discussed and rediscussed 
among large numbers who ordinarily would never give it a passing 
thought". Hope is still very much alive and we are looking forward to 
Inning a dental clinic in Kamloops, and that in the wry near future. 

I wish to pay tribute to the manner in which Dr. Young rendered 
assistance. Never once was I disappointed when I turned to him for 
advice, and the encouragement I received always brought fresh hope. 

Marion Fisher. 



KEEPING THE OUTLYING SECTIONS OF A RURAL COMMUNITY 
SATISFIED WITH THE SERVICE THEY RECEIVE. 

In order to keep the outlying sections of a community satisfied with 
the service thev receive, it is necessary to keep in mind the following 
facts :— 

(l.i The residents have less actual contact with the world of affairs, 
and for this reason probably have more time to think of the service thev 

I r «, 

expect and the service they receive. 

(2.) They in all probability value the service given them more than 
do the residents of the towns and cities. 

(3.) There is a feeling (quite natural) in the outlying sections that 
if the nurse is very busy (overworked) the outlying districts will be 
the first to suffer, knowing that the nurse Mill attend to the nee:l that 
can be relieved at once. 

(4.) The following points art 1 to be remembered when working in a 
rural district : — 

(a.) Keep in touch with the health problems as they arise by organ- 
izing a local committee, the convener of which committee should he a 
member of your Central Committee, and whose 1 i]^iy if is to report to you 
at once any problem, such as an epidemic arising in the district. 

(6.) Work for the close co-operation of the teachers and the members 
of the School Hoard, as well as that of the resident doctor, if there is one. 

(e.) Visit the rural school monthly, making your routine class-room 
inspection, even if for some reason you are behind in your schedule and 
it is necessary to postpone some important town work. 

12 



id.) Get acquainted with the parents through home school visiting, 
even when there arc no defects to report; the parents will be glad to have 
yon tell them so. 

(e.) Visit the local committee convener after making your monthly 
visit: to the school; give her a summary of the business transacted at the 
last Centra! Committee meeting if she was unable to he present; also 
visit at least one member of the local Board. Do not he afraid of wasting 
time on co-operative visits; it is not time wasted, but time well spent, 
especially in rural districts. 

I. M. Jeffares. 



PERSONALS. 



The first of the public-health nursing students from the University 
to come to the Cowichan Health Centre for her rural field-work was 
Miss Hazel Brunker, who arrived February loth. Since then Mrs. M. 
Hyde and Miss Anne Iledley have spent two weeks at the Centre, and 
Miss J. Campbell is expected on the 29th. 

* * -* * * 

On February 28th the nurses at the Cowichan Health Centre enter- 
tained at luncheon in their quarters, the guests being Miss Morrison, 
President of the Victoria Graduate Nurses' Association; Mrs. Osborne, 
Victoria School Nurse; Miss McCormack, of the V.O.N., Victoria; Miss 
Buckley, Victoria Dental Nurse; Miss Florence Fullerton, Saanich Health 
Centre; Miss Woods, Nanaimo School Nurse; and Miss Davie, of Lady- 
smith. After lunch the visitors were taken for a drive through the 
district. 



VICTORIA, B.C. : 
Printed by Chaules F. Banfield, Printer in the King's Most Excellent Majesty. 

1925. 



S00-425-539 

13 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. |' APRIL, 1926 No. 3 

PROGRESS and improvement are proven by the evidence of actual 
accomplishment. The truth of this statement, if applied to public- 
health nursing, is shown by the subject-matter of the papers that have 
been furnished by the Public Health Nurses of British Columbia which we 
are able to publish in this the third number of the Bulletin. 

As the work is carried on dav by day the difficulties encountered seem 
to be without end and one 'begins to feel verv much like the man who 
" could not see the forest for the tress." 

In reading- the papers submitted, the orderly arrangement of the trees 
becomes apparent and one realizes that it is through orderliness and 
steady growth that the forest becomes possible. 

Sunshine is breaking through the foliage, the shadows are disappear- 
ing, the ground is drying, and progress along the road to health is being 
made. 

The progress is very evident when comparison is made with previous 
issues of the Bulletin. It is quite apparent that difficulties are being 
overcome, the scope of the work is being enlarged, and as the development 
proceeds the nurses are unconsciously learning that real success can only 
be obtained by utilizing every avenue of approach toward the formation 
of a curriculum, the object of which is the establishment of " health 
habits." In other words, they are learning that a better balance in health 
services can be maintained by generalization than by specialization. 

Norman R. Carter, D.D.S., called the attention of the Provincial 
Board to the necessity of attending to the dental work in a number of 
small schools in his district on the Arrow Lakes. We were only too 
glad to co-operate and we wish to express our appreciation of the manner 
in which Dr. Carter handled the situation. At a small cost and with a 
great deal of personal inconvenience, he went through and we are very 
thankful that the children have been taken care of. We are also thankful 
that we have found a gentleman with a sense of public duty, through 
whose representations the Board was able to act. We are publishing two 
articles in this Bulletin from the Doctor's pen. 

The Provincial Board of Health is verv conscious of the hearty co- 
operation that it is receiving from the nurses of the staff. We are building 
up a personnel of which any department may be proud. 

In addition, our efforts are to be supplemented by the direction and 
advice of two outstanding figures in public-health work. We are fortunate 
indeed in the fact that the University of British Columbia has added to 
its staff Miss Mabel Grav as Assistant Professor of Nursing and Dr. W. 
H. Hill to be Professor of Bacteriology, Health and Nursing. 

Miss Jeffares, of Duncan, is the responsible Editor for this issue, 




y. 



y. 












(tf; 



■f- 






ST' AM. 



TABLE OF CONTENTS. 

PAGE 

Editorial. 1 

Conservation of Children. By Katherine Glover 4 

The Public Health Nurse at Keremeos. By Olive K. Gawley, R.N. (> 

School-work in Armstrong. By P. A. Charlton 8 

Greetings from Pioneer Say ward. By Edith M. Walls 

Esquimalt Rural Nursing Service. By H. Kelly, K.N i) 

Qualicum and District. By II. Murray, K.N 11 

Public Health as a Career. From the " New York State Bulletin " 12 
Problem of Mouth Health among Children in Rural Districts 

of British Columbia in Relation to Public Health Nurses. 

By Norman R. Carter, D.D.S. 12 

Public Health Nursing in Ladysaiitii. By S. A. Hewertson, R.N... 14 

Ka.mloops. By J. Campbell, R.N 14 

Dental Clinic for Rural Schools in Arrow Lakes District. By 

Norman R. Carter, D.D.S. 10 

School Nursing in a Mining Town. By Jean A. Dunbar 17 

The Public Health Nurse at the Fall Fair. By M. R. McClung, 

R.N IS 

Fall Fair Exhibits. By I. M. Jelt'ares 18 



'6 



(American Child Health Association, 370 Seventh Ave. New York, N.Y.) 

CONSERVATION OF CHILDREN. 

Governor Pinchot, of Pennsylvania, the great advocate of conservation, 
said in a May Day proclamation last year: ''Children can be consumed 
as well as trees. No one with any sort of common sense or patriotism 
questions the essential wisdom of the conservation policies initiated by 
Theodore Koosevelt, which first were restricted to the natural resources 
of our country, its forests, its coal, its oil, its minerals, but which gradu- 
ally have broadened. It is inconceivable, therefore, that any one will 
question a still higher form of conservation, the conservation of the health 
of our children. The babies of to-day will, in a generation, be the man- 
hood and womanhood of America, guarding its ideals, controlling its 
destinies. It is a duty than which nothing can be plainer, to give at least 
as much thought and care to these children as we do to our natural 
wealth. No substitute will ever be found for healthy children." 

We have come at last to that highest and most fundamental economy, 
the conservation of our children. Ellen Key, the great Swedish writer 
and philosopher, af the opening of the twentieth century christened it 
" the century of the child." The first quarter of this century has rounded 
to a close, and, pausing to reckon its achievements, nothing stands forth 
more conspicuously than the changes it has brought in the lives and 
prospects of children, the efforts which have been inaugurated looking 
toward the conserving of child life and happiness, the changed attitude 
towards the child. ; 

In these twenty-five years we have cut the hazards of life for the newly- 
born child in half. Where two babies died at (lie beginning of the century, 
only one dies now. 

Largely due to the increased protection of children in the early years 
of life, the average span of life has been lengthened by nearly ten years 
within the past twenty-five years. 

A new protective government machinery for promoting the health of 
children has been set up in the Children's Bureau. 

An appropriation, jointly Government and State, for the protection of 
maternity and infancy, created through the Sheppard-Towner Act. is a 
concrete acknowledgment that our children need care, study, and pro- 
tection, as well as our agricultural resources. 

Public Health Boards, newly roused to the need to conserve human 
health, are turning their attention to the group where the greatest danger 
and the greatest hope lie — the children. 

In our schools education has expanded to include the physical needs 
of children as well as the mental. 

It is in keeping that, at the close of this first quarter of a century, 
which has accomplished more to ensure the rights of children than in- 
numerable centuries preceding it, there should he launched a festival day 
to celebrate all that has happened and to look forward to greater achieve- 
ments. That is the significance of May Day for Child Health, a national 

festival of childhood. 

4 



May Day, 192G, is the third of these celebrations. Each year has 
marked a decided increase of momentum and each year leaves a perma- 
nent deposit of encouragement and constructive effort. This year attention 
is focused upon the perfect child. Every community through the country 
is urged to examine into the well-being of its 1 children, to see them in com- 
parison with perfect childhood, and to set in motion some endeavour 
which looks towards that goal. 

These are a few facts which should arouse us to national and local 
efforts to conserve child-life. 

Of the 1,500,000 of our population who die each year, it has been esti- 
mated that 42 per cent, die from preventable causes. This 1 waste occa- 
sioned by this preventable loss is estimated at a billion dollars. 

Forty thousand school-children die each year from causes which are 
preventable. 

There are 400,000 cases of typhoid fever each year, 10 per cent, of 
which are fatal, and To per cent, of these cases are unnecessary. 

Diphtheria, which is considered preventable and for which there has 
been a curative for thirty years, takes the largest toll of death among 
children of airy of the five common communicable diseases. 

Of all crippled adults, one-third receive their injuries during the first 
six years of life and a very large percentage are needlessly handicapped. 

One hundred per cent, of all mental defectives are recognizable during 
the first six years of life. 

Besides the clarion message, " May Day is every child's day," which 
was carried in parades and pageants, the May-pole programmes, through 
the radio, the press, proclamations of the President, and of governors and 
public-health officials, these are some of the unusual things which com- 
munities did last year as. a result of May Day: — 

Forty thousand citizens of one city waked up on May 1st to the greet- 
ing on the caps of their milk-bottles: " Good-morning; this is child-health 
day." 

All mail from the Board of Health in one State for a month carried 
the slogan : " The firsit of May is everv child's dav." 

Throughout one Stale the committees appointed for May Day resulted 
in small committees to form a permanent nucleus for the protection and 
promotion of the health of children. 

Several communities in the same State set themselves upon baby hunts 
for the year 1925-20 to check up on its fundamental human book-keeping 
and to discover the needs of their babies. 

Department stores in various parts of the country held baby weeks. 
In some stores a thousand or more babies were examined by doctors and 
nurses and many thousand mothers received guidance on 1he care of their 
children. 

In one State a beginning was made to get local committees to present 
to the people of their communities an exhibit of the services which are 
available for the health of children in their communities, with the idea of 
following up through the year with a study by a careful group in each 
district of the health needs of the children within their district. 

5 






Another State started on a campaign to make every day a child-health 
day by issuing a. Child Health Club card. Any child whose parents promise 
to have him examined periodically and to use every effort to correct de- 
fects and bring about better health along constructive lines may become 
a member of the club. 

In another place a Health and Happiness League was inaugurated. 

In others drives were started to round up the pre-school children and 
see that they are a hundred per cent, fit before entering school. 

May Day was, in fact, a great national rally day in this new human 
conservation. Tt will be a greater rally day this year. 

Mr. Hoover lias said: " Each year Hie results will double until it has 
become a national habit, an almost subconscious impulse, to remember 
the child wisely, constructively, from the day that parents are born until 
the day their children become parents; that is, always. Then no words 
of any one man or woman will be necessary in defence of the nation's 
will that its children shall be well." 

Katiierixe Glover. 



Till'] PUBLIC HEALTH NURSE AT KEREMEOS. 

My long experience in public-health work in cities, towns, and rural 
sections of Ireland and British Columbia comes to my assistance in an- 
swering the following questions asked me by nurses and others in British 
Columbia. 

In cities and large towns there are many organizations of infinite value 
to a Public Health Nurse in her work, and no matter how strenuous it 
may be, it is a sinecure compared with the duties of a rural nurse, who 
so often must take 1 the initiative in many activities in her district. 

All Public Health Nurses should be blessed with the three virtues, 
Faith, Hope, and Charity, and remember the greatest of these is Charity; 
but she must have Hope and she must have Faith, and she need not expect 
Charity. She is an outsider (I write now of the rural) whose presence 
may be resented, whether young or old, staid or gay, pretty or plain (we 
have no ugly nurses). 

She is a public servant sent to that district by request of the majority 
of the people, but the minority (until they require her service in trouble 
or illness) may consider her upkeep a waste of good money. 

She must remember that every move is noted and criticized either 
favourably or otherwise, according to the spirit of the critic. 

The private-duty nurse also considers the Public Health Nurse usurps 
her place, forgetting that 1)0 per cent, of the cases would be undertaken 
by untrained help. The medical profession are conservative and. as at 
the beginning of district and other forms of nursing, were prejudiced. 
However, they are gradually getting to know the help a Public Health 
Nurse may be to the Medical Health Officer as well as to the man in 
general practice. 

There are cases that must be transferred to hospital; still, I believe, 
two-thirds of the patients treated in institutions at the present time could 

6 



with the supervision of a Public Health Nurse be cared for in their own 
homes at a minimum of cost to patient and community. 

When we realize the anguish caused by separation of families, it 
surely must be a detriment to the perfect peace of mind necessary to our 
invalid's welfare. 

Our people must know and understand much more than they do of 
illness and its causes and prevention of complications, but are we doing 
our share in this? Do we consider ordinary men and women capable of 
nursing a serious case, such as typhoid, pneumonia, or even a minor 
operation? I fear we do not; but to my personal knowledge serious cases 
have been nursed successfully at home, with the supervision of a Public 
Health Nurse and the co-operation of a physician or surgeon, at about 
one-sixth the expense, which alone is quite a consideration to many house- 
holders 1 at the present time. One such case will do more to gain friends 
for our work than "yards of speeches" and the nurse's advice and help 
will be sought by old and young; even the black sheep of the district will 
learn to respect her and to come to her for sympathy and advice. 

Olive K. Gawley. 



QUERIES AND ANSWERS OF A PUBLIC HEALTH NURSE. 

1. What is a Public Health Nurse? — A graduate nurse, who after- 
wards has a special training in prevention of disease and the care of the 
mentally, physically, and morally ill. 

2. What are her duties? — To do all in her power, by precept and ex- 
ample, for the good of the community in which she works, the prevention 
of disease, and the alleviation of suffering. 

•°>. Is it necessary for a highly trained, competent nurse to take special 
training before attempting public-health work? — Yes. The hospital and 
private-duty nurse is trained to personally care for the patient or con- 
stantly supervise the work of probationers. The Public Health Nurse 
must teach untrained assistants, who may never find it necessary again to 
care for the sick, in order that thev mav for the one particular case. 

4. Should a nurse on the staff understand the financing of the service? 
— Yes. 

5. Should the nurse of higher capabilities be sent to the rural or urban 
districts? — The nurse with the very best training should be sent to the 
rural district, as in many cases medical and surgical assistance is scarce 
and the nurse must take responsibility, owing to lack of adequate trans- 
portation and oftentimes poor roads. 

(5. Why do many capable Public Health Nurses object to rural or small- 
town work? — Want of congenial companionship, very poor housing ac- 
commodation, with few modern conveniences to be found in the homes. 
Also inefficient transportation and a general prejudice among the people 
to any innovation that is hard to combat. 

7. What is the best means of financing the service? — Provincial health 
tax and school tax. 

8. Can a Public Health Nurse in a district prevent higher taxation, 
and in what way? — Yes. By prevention of epidemics; by prevention of 

7 



semi-invalids, who are so through preventable diseases; by prevention of 
waste in educational benefits caused by defects that may be remedied or 
prevented; by child-welfare or prenatal service, including the prevention 
of abortions, which often are the upshot of the dreaded expense of child- 
birth. 

0. Why should a Public Health Nurse expect the highest salary in the 
profession? She has a wider education, more responsibilities, and more 
strenuous work and nerve strain than any other nursing; section, 

10. Why should the Christian churches take an interest in Public 
Health Nursing? — The greater part of the ministering of Christ was 
shown in helping those in trouble and distress, in healing of the sick, and 
the care of the children. 

11. If mothers! are indifferent to nurse's advice, should visits be con- 
tinued in that home? — Yes, in a social way, always remembering that, no 
matter how hard the ground, some seeds will germinate. 

Olive K. Gawley. 



SCHOOL- WORK IX ARMSTRONG, 

One of our greatest problems is the large number of malnourished 
children. Why this condition should exist in a district so far famed for 
its dairy and vegetable products is) hard to say. Probably the long truck- 
drive, necessitating the children to start out at an early hour and arrive 
home in the early evening, has something to do with the condition. 

Quite a number have had defects remedied and already show great 
improvement. We hope to hold a tonsil clinic in the summer and we are 
already planning a two-weeks' outing for those who would not otherwise 
get a change. 

Since the New Year a hot drink, cocoa or sou}), has been served to the 
pupils staying for lunch. 

Nutrition classes have been started. In the junior rooms they are 
having rest, milk-drinking, and vegetable-eating competitions. Some of 
the teachers have devised various devices for adding zest. In one room the 
underweight pupils have pasteboard houses which they are shingling. 
Each shingle is shaped like a milk-bottle and represents a quart of milk 
taken. In another room a mountain-climbing expedition was started, the 
pupils making the climb from Danger Valley to Safety Peak. Some of the 
pupils have gained as much as lb. in one month. 

It has been harder to interest the senior pupils, but quite a marked 
improvement has been made since they have made graphs, on which they 
keep their weekly record. A prize has been offered, to be given the last 
of June, for the graph showing the best record and resuilt. 

In September 72 per cent, of the pupils were underweight. At the New 
Year this rate had decreased to 13 per cent. Although this is but a step 
in the right direction, there is a long road to go yet and the goal can 
only be reached by untiring effort and interest. 

P. Charlton. 

8 



GREETINGS FROM PIONEER SAY WARD. 

Time changes all things. It is now four years since I was appointed 
Health and District Nurse for Say ward, and in place of past opposition 
and ignorance of my work I now feel that the majority of the residents 
realize I can be of assistance to them and apply to me for help from 
time to time. 

In the two schools in Say ward Ave have Health Chore Crusades, the 
children receiving marks for the " chores " attended to daily ; a prize 
being given at the end of the term to the one receiving the largest number 
of marks. 

Wishing my fellow-workers the best of luck in their various 1 under- 
takings. 

Edith M. Walls. 



ESQUIMALT RURAL NURSING SERVICE. 

Previous reports have dealt chiefly with the inauguration and aims 
and o'bjects of this association, the area covered, and the difficulties met 
with in establishing the service, etc. 

In this report I propose to deal with the growth and development par- 
ticularly, though it will be necessary to go back at times and refer to 
early difficulties in order to show clearly the comparison between now 
and then. 

We are still faced with the difficulty of " rendering account," although 
there is quite a different spirit existing now among the more intelligent 
people — those who are observant and who carry an open mind and are 
prepared to listen and learn. 

To render account in public health is a difficult matter, and seeing that 
our capital comes from the public it is only reasonable to expect that we 
should be prepared to render an account of our stewardship. As far as 
the expenditure of the money entrusted to the officers of an association 
is concerned, an accurate account can be given, but the real and actual 
returns for the investment cannot be put down in black and white; they 
are only materialized in the improved health of the district in which the 
service operates. 

Such things as the development of right habits of living, the breaking 
of wrong habits, and the eventual evidence of the benefits of a public- 
health service are of naturally slow growth. Therefore for the first two 
or three years after the inauguration of such a service the committee in 
charge have a hard road to travel, and are often faced with the question, 
" What are we getting for our money? " 

It takes a considerable time to educate the people to the fact that a 
Public Health Nurse is not merely there to attend the sick — she is there 
to teach the people not to be sick, but to obtain health and keep it; but 
they do become educated in time, though much patience and perseverance 
is necessary for a time. Of course there will always be the few who refuse 
to see, but luckily they are in a comparatively small majority and merely 
serve as an incentive to better work as a general rule. 

9 



One notices with gratification the different outlook of the parents to- 
wards the work of the nurse. At first the natural question in reply to 
the information of the child that "nurse came to school to-day" was 1 , 
" Why, who is sick? " But now it is, " What has the nurse heen teaching' 
you to-day? "'■ Then take the prenatal work. How many young mothers- 
to-be have said to me after I have visited them and talked with them, 
" Why! I didn't know; 1 had no idea that I could do — or fail to do — so 
much for my baby." What a different aspect is put on the case when, in- 
stead of ignorant, if well-meaning, commiseration and " you poor thing " 
from sympathetic neighbours, the expectant mother receives a visit from 
a cheerful nurse and hears: ''You glorious creature, what a wonderful 
thing is going to happen to you. 1 wonder if you realize how very im- 
portant you are and what you are responsible for." And then, by carrying 
out the nurse's instructions, in reply to inquiries over the phone the 
answer is given: "A fine baby; yes, mother and child doing well." And 
this part of the work is fully realized by the people in the districts covered 
by the above service. 

Then the careful watching of the care of the infants; the children 
of preschool age; the school-age children and the budding youth. All 
this comes under the heading of "Public Health Nursing." All this? — 
and how much more? 

In January of this year we held our sixth annual meeting and the 
growth and development of the service has been remarkable. The people's 
money has been handled economically, good service has been given, and 
their confidence won. In the five schools in my district the trustees and 
teachers give excellent co-operation. The children enjoy and take a keen 
interest in their health drills and exercises and my Girls' Health Clubs 
continue to be a great success. 

This year — in May — I am co-operating with the teachers in staging a 
children's pageant; this will be on quite big lines and my part of it will 
be the health side. As many of the children of my districts as possible 
will take part in this pageant and the people will be given an opportunity 
to'see the value of health-teaching. 

Two dental clinics a year are held, which means an examination of 
the teeth of all the children in the five districts comprising the E.Ta. Health 
Centre. During the midsummer and Easter vacations all the children 
whose teeth need attention, if the parents are willing for the work to be 
done under the auspices of the service, receive expert attention. And we 
find that the two clinics per year are sufficient and keep the cost of ad- 
ministration down to a minimum. Of course, each month the nurse ex- 
amines the teeth of the children at her monthly inspection, and any work 
necessary is done by the regular dentisrt at his office in town, the nurse 
transporting the children to and fro. Thereby the teeth are kept in con- 
dition and the foundation of good health laid. 

Slowly but surely the public are being weaned from their conception 
of the mission of a Public Health Nurse. The mental vision (so ofttimes 
even pictured) of an "Angel of Ministry cooling the fevered brow of the 
sick " sort of person cannot continue to exist in the face of the busy, 
healthy-looking, health-teaching nurses out in the field in public-health 

10 



work. Instead we have the vision of a teacher teaching health exercises, 
toothbrush drills; teaching the value of supervised play, exercises to de- 
velop the lungs and muscles and bone of the growing child; teaching the 
mothers how to teach the children, and getting her reward in the dem- 
onstrated confidence of the children and parents and the evident improve- 
ment in the general health of the districts in which she works. The upkeep 
of a Public Health Service is really an insurance against sickness, as by 
the visit and a word of advice in time from a competent and qualified 
nurse often a serious sickness is averted, because the nurse knows 1 and will 
advise the calling-in of the family doctor immediately when necessary; 
therefore the answer to the question, " What are we getting for our 
money?" is, "In so far as possible, an insurance against sickness." * 

My conception of an ideal health centre is somewhere where the chil- 
dren gather to play under proper supervision, where the mothers will come 
for advice, where health club meetings can he held; in fact, a training 
centre for health where anything even suggestive of sickness is strictly 
taboo. I do not think that the day is far distant when this conception 
of a health centre will be more or less general. For my own part, with 
regard to my own work, that is my aim, and I am pleased to say that I 
am backed by my committee. 

II. Kelly. 



QUALICUM AND DISTEICT. 

Here we have a newly organized " public-health district." Less than a 
year ago several hundred people around here did not know or have any 
idea what a Public Health Nursing Service represented, but now every- 
where one hears of our Health Nurse and daily new questions arise con- 
cerning the work. 

I am very fortunate in having a strong committee who are interested 
in all welfare and health work, perhaps more particularly in that branch 
which deals with disease prevention. 

Just recently there were a few cases of scarlet fever in a district not 
far from mine, and the watchful eye kept on the school -children of my 
district, as well as the visits paid to absentees, appealed to many members' 
of the community who had up to then been indifferent. 

The day's work is considerably varied in a rural district; for instance, 
we start out in the morning to see a delicate and sicklv babv who is cared 
for by a young and inexperienced mother. The little mite seems to recog- 
nize the uniform and manages a sicklv smile. You may be sure any in- 
struction and advice given is very welcome here. While in that corner of 
the district there is a wound to be dressed. An unfortunate man has 
badly mangled his hand in some machinery at the mill, and as the doctor 
lives in a town some 30 miles distant the District Nurse has been in- 
structed to do the dressing. 

Probably we have planned to do a school examination after the last 
two calls, but on phoning Central find that a prospective mother requires 
our services at once, and so off we go in the opposite direction, thinking 
of the old saying, " The best-laid plans of mice and men, etc." 

11 



The quickest and best results are perhaps to be found in the schools, 
the gradual decrease of physical defects going far to prove the value of 
pre-school and school supervision. 

H. Murray, R.N. 



PUBLIC HEALTH AS A CAREER. 

Choose a public-health career for two reasons only — because it attracts 
you and because j^ou believe yourself fitted for it. 

You have broad technical knowledge. Give others the benefit of it, but 
only as occasion requires. 

Official representatives of the people and the people themselves may 
not understand public-health work, but frequently possess other knowl- 
edge which may be of service to you. 

Maintain }"Our dignity at all times, but do not stand aloof from human 
contact. 

Make many friends, but few intimates. 

Be a good listener, but not too ready a talker. 

Practice public speaking. Eloquence is a rare gift, but is not essential 
to the command of respectful attention. 

Be loyal to your associates and true to yourself. 

Never permit political sympathy to influence an official act. 

Be not oversuspicious of evil intent. Give every one the benefit of a 
doubt. 

Be willing to grant favours to all those that seek them worthily, pro- 
vided that it is not incompatible with the performance of your sworn duty. 

Have vision, but not be visionary. 

Lead the procession always, but look behind once in a while to see if 
you are being followed. 

If you cannot obtain all your objectives, take what you can get, and 
try again. 

Know when vou are beaten, and take vour defeat gracefully. 

Be willing to compromise in order to reach an objective, but never 
with your conscience. 

Frankly acknowledge a mistake, but do not make it a second time. — 
From the " New York State Bulletin." 



PROBLEM OF MOUTH HEALTH AMONG CHILDREN TN RURAL 

DISTRICTS OF BRITISH COLUMBIA IN RELATION 

TO THE PUBLIC HEALTH NURSES. 

The pain and trouble, the lost time in the school-room, the impaired 
digestion and general irritability of the child with toothache is obvious to 
you all. The after-effects evidenced in crooked and ineffective teeth, in 
rheumatism, in heart-troubles, in dental bills for restorative operations, 
and general susceptibility to infectious diseases are being generally recog- 
nized. 

The answer is prevention. 

12 



Get these children to the dentist as soon as possible. As a rule, if the 
child has toothache the mischief is already done, there. Prevent the 
trouble. Stop it before it starts. Carry this message, personally wherever 
possible — congratulating- the child that evidences a well-kept mouth and 
kindly admonishing the many who require it. Your words and your 
occasional visits are much more momentous things to the little child than 
vou dream. 

Instruct and encourage the parents; giving information about the 
sixth-year molars, the loss of which is so general and such an appalling- 
matter. Show them the importance of continually keeping after their 
little ones to brush their teeth with some intelligent thought; appeal to 
that universal desire in parents that their children have opportunities 
superior to their own, and urge that existing faults be remedied by the 
dentist at the earliest opportunity. 

The teacher's influence in the school is probably greater than any other 
outside the home, and fortunate indeed are those children who have an 
aesthetic example given them there. Stand back of the teachers with 
health talks, distribution of health cards, samples of dentifrices, etc., at 
the psychological moment, and through them act and talk always 1 as 
though the dental clinic and the dentist's services are happy and most 
desirable privileges. 

Prevent mouth-troubles by urging cleanliness and having the mouth- 
tissues in such shape that vigorous use can restore tone and comfort and 
health. 

At the present time we believe that the entrance to our bodies is best 
cleansed by the use of a toothbrush; what is used upon the brush is of 
less importance, although a dentifrice makes the toilet a more pleasant 
task. One can brush the teeth a great deal without cleansing them. Watch 
this and see that the brush is intelligently used. Use lots of water, rinsing 
and regurgitating this back and forth till all signs of dentifrice or food 
debris disappears. The important time to do this is previous to retiring 
at night, but urge that it be done after meals or whenever the children 
realize that the mouth feels unclean. Appeal to them to have the inside 
of their face as clean as the outside, or that their teeth be cleansed as 
often as the dishes and other utensils connected with meals. Children 
get this idea, I find. The point is, Repeat it; stick to the repetition : don't 
be discouraged; by so doing you prevent these troubles before they start. 

But, if they have started, perhaps these hints will be of benefit as a 
matter of emergency relief: Tincture of iodine used as a counter-irritant 
on the gum adjacent to the aching* tooth will help. Dry the gum a little 
and wrap a wisp of cotton around a toothpick to make the application. 

On a tooth which cold affects, and possibly aching after eating, where 
the trouble seems to be from a living nerve-pulp — clean the cavity of 
debris, if possible; apply a little ball of cotton about the size of a pin- 
head, dipped in oil of cloves, and cover with a larger piece of cotton. 

Where the face is swollen, aching perhaps at night and upon lying- 
down, with hot drinks, etc., hurting, use beechwood creosote, as before, 
on cotton. 

When in doubt use creosote. 

13 



Don't apply heat to the face; no hot-salt bags or hot-water bottles. If 
you must use heat, give a hot foot-bath — that will help. Do this and give 
ispirin in small doses if the person is in agony. And don't forget a good 
cathartic, one that will make a watery stool; not a lubricant like oils, 
but Glauber salts, Epsom salts, fruit salts, etc., given in medium doses, 
but over a longer period than you think necessary. Have the patient 
drink much water. 

But the best way to cure toothache is to prevent it before it starts- 
get that point over and the problem of mouth health among all mankind 
is well faced indeed. 

Norman R. Carter, D.D.S. 



PUBLIC HEALTH NURSING IN LADYSMITH. 

Ladysmith being a mining town, practically all the men are employed 
in the mines and a deduction is made from their salary to take care of 
the hospital and medical treatment. 

Apparently this is the reason a great many are opposed to the idea of 
a Public Health Nurse for the town. The nurse, however, is gradually 
being appreciated, especially in the control of infectious diseases. The 
children being inspected monthly, any case of suspect infection is reported 
at once to the doctor and the child excluded. 

Much pleasure is derived from home-visiting, as this gives the parents 
an opportunity of asking for advice and discussing the minor defects of 
any other members of the family. 

The majority of the children are showing an increased interest in 
their personal appearance by keeping their teeth clean and by living up 
to Hie Health Rules. This is perhaps more noticeable in the rural schools, 
where children of all ages are in the same class-room. 

S. A. Hewertsox, R.N. 



KAMLOOPS. 

The pleasant first impression one receives of this little town is a last- 
ing one, and especially is this so in fall, when the homes are covered with 
crimson Virginia creeper and lawns and boulevards are still fresh and 
green owing to an excellent irrigation system, whilst the background of 
brown foot-hills covered with sage-brush helps to enhance the vivid colour- 
ings of flowers and lawns. 

The Medical Officer of Health is also school doctor and I had already 
met him, but to become still better acquainted with the work in the city 
I visited all the doctors, six in number. 

They were exceedingly friendly and offered their services) whenever 
necessary, but also informed me there would be no bedside nursing re- 

14 






quired, adding- I would find plenty of other work to do, especially in the 
schools. 

Why no bedside nursing? The reason was not far to seek. This is a 
railway town and has an excellent hospital with a training-school. The 
doctors look after the employees and their families under a special agree- 
ment with the railway companies, and under the same agreement the 
employees have a certain amount of hospital facilities free. 

With a population of about 5,000 one naturally would not expect 2 
large school enrolment, but in the public schools there are 1,000 children, 
whilst a number of children attend the Convent and private school. 

I soon found there was much to be done along health lines' in the 
schools, and as the classes are somewhat divided up owing to lack of 
accommodation, one school having classes in three buildings in different 
parts of the town, it meant much walking and dividing-up of time when 
making out a time-table. 

Teachers and children take a great interest in their health-work, with 
the usual few to make the exception, but a more congenial and co-oper- 
ative group would be difficult to find. 

The same may be said of the parents, perhaps the enthusiasm of the 
children helping to some extent, for the home-visiting is one of my 
pleasantest duties. 

The girls in. one class have for two months in succession gained 100 
per cent, for having all physical defects attended to, their record for 
cleanliness also being 100 per cent., whilst the boys gained 1)8 to 09 per 
cent.; those who had brought down the record were turned over to the 
others to see what could be done with them during the ensuing month. 
Of course life would be too easy if all classes were equal to this one. 

A little girl who is especially neat and clean one day informed her 
mother that she was going to take a holiday from the cleaning business. 
Her mother was rather astonished and asked the reason. Well, the nurse 
would not be in their room for a day or two as she had counted the rooms 
so she was going to have a rest. Her mother cautioned her and explained 
that it wasn't specially for the nurse that she formed health habits; but 
no, off she went. On her return that afternoon she was rather crestfallen. 
Having forgotten the morning incident, her mother was much surprised, 
on inquiring what was wrong, when the little one answered: "Mother, 
you are disgraced for life and I'm disgraced for life, for the nursie did 
come to our room and brought the doctor with her and he just pointed 
at my finger-nails." 

A very pleasing feature of the work is the well-haby clinic, which is 
held under the auspices of the Red Cross Association. The mothers ap- 
pear to enjoy coining and meeting each other and comparing notes about 
their babies, and I believe more than one good friendship has resulted. 

I also find this a good opportunity for having little chats with the 
mothers about some of their children who are not of school age. 

The Kamloops Junior Brotherhood does much to develop the sports 
side of the children's lives, emphasizing that sport must at all times be 
clean throughout and their record as basket-ball players shows the effect 
it has had upon them. 

15 



Almost every one in the town belongs to a society or lodge and much 
good work is done by the members of these various associations, but I feel 



sure that if a Parent-Teachers' Association or Women's Institute were 
formed much could be done in getting school and playground equipment 
that would be of great value to the children. 

Meanwhile Kamloops, with its clear air and bright sunshine, remains 
a very delightful place to live in. 

J. Campbell, R.N. 



DENTAL CLINIC FOR II TEAL SCHOOLS OF ARROW 

LAKES DISTRICT. 

During the past summer (1925), thanks to the Provincial Board of 
Health, a dental clinic was made available to the children in this area. 

There are sixteen schools, with from eight to twenty pupils in each, 
distributed along a lake of about 120 miles. 

In June a preliminary survey was undertaken, estimates made, and 
examination cards sent to parents, who were asked to pay one-third of 
the expense involved in doing the required dentistry for their children. 

In September and October the dentist visited each point by launch, 
staying the period required to complete the work for those desiring it; 
setting up his equipment in the nearest available point to the school — 
sometimes in the living-room of a ranch-house or a summer-home verandah, 
the meeting-hall of the Women's Institute at one place, and once in what 
had been the bar-room of a country hotel. 

The children were excused by the teacher in couples as a rule; the 
pupil with work completed sending back another on his return to the 
school-room. In this manner we disturbed the classes as little as possible. 

When the work of each .school was completed the dentist distributed 
literature and addressed the school on mouth health and care of the 
teeth. On account of his personal contact whh each individual present, 
this was an ideal occasion and the message was put over in a very in- 
timate and effective manner. Hardly any of these children had ever been 
attended by a dentist previously. As a rule they came to us absolutely 
unafraid, and despite the fact that often their work was of a most exact- 
ing nature we had no undue trouble with any of them. We found it best 
to take first the youngest pupils in a group, doing deciduous extractions 
and prophylaxis for them, calling the older pupils later, rather than the 
reverse order. When the babies seemed to not mind it all. the older ones 
were less apprehensive. 

At some points the dentist was received by a committee and treated 
like a hero; at others he would waste hours getting some one with a "go- 
devil " to transfer his baggage. At some points the whole populace seemed 
enthused; at others perhaps only the teacher or a single member of the 
School Board were " leaven to the whole lump." 

In two schools not a single card was signed by the parents; in nine 
schools all cards were signed; in eleven schools all scholars availed them- 
selves of the privilege and all work was completed, 

16 



Not 10 per cent, of these children had ever seen a dentist before, yet 
we found a half dozen perfect mouths among them. To offset this, how- 
ever, there were about a dozen children from 12 to 15 years of age whose 
mouths were absolutely ruined, these requiring often more attention than 
all the rest of the school together. AYe regret to say that it was this class 
of scholar (those who needed it most) who too often avoided the clinic. 

However, outside of the direct benefit to the children, the dental clinic 
has awakened a real interest in mouth hygiene. Often where only a small 
per cent, of the parents signed cards, when the clinic actually presented 
itself every one in the school came in as the work progressed. Inquiries 
concerning another such opportunity are constantly coming in. May good 
fortune attend this pioneer work. 

Norman E. Carter, D.D.S. 



SCHOOL NURSING IN A MINING TOWN 

Fernie is a mining town with a population of about 5,000, situated in 
a valley along the south-eastern borders of British Columbia. My first 
impression on arrival was one of absolute isolation, which feeling, how- 
ever, gradually disappeared as I found the people, though about one-half 
foreign-born, were both hospitable and interesting. 

In Fernie we have 1,000 school-children, attending one large grade and 
high school and two primary schools at separate ends of the town. At the 
first meeting of the School Board I attended it was suggested, among 
several other matters, that perhaps it would not be wise for me to ap- 
proach the parents on the subject of malnutrition. As there were a large 
number of underweights among the children, I felt something should be 
done until such time as it would be advisable for me to do so, and the 
following plan was decided upon :— 

After each monthly inspection I now divide the class into three groups 
(when necessary) ; all of average weight and over receive irhile lags, those 
from 1 to 7 per cent, underweight receive blue tags, and those over 7 per 
cent, underweight receive red tags. T explain to the children in the 
class-room what the different colours mean and have them repeat the 
following : — 

Cards of white all right, 
Cards of blue 'won't do, 
Cards of red, danger ahead. 

I then urge them to see how quickly they cmi all receive white cards 
and so compete with the other rooms in the school. 

A Health Fairy's House. — Tn the junior rooms I have found that the 
making of the Health Fairy's House is of assistance. It is made from a 
sketch of a house built of bricks, with shingled roof and fancy windows. 
The children are told the story of how the Fairy becomes beautiful by 
keeping all the health rules, until the wicked witch "Ignorance" visits 
Fairyland and burns the Fairy's house down. The Fairy's friend Happy, 
the Health Clown, comes to the Fairy's assistance and together they plan 
how the Fairy's house can be rebuilt, stronger and prettier than ever, 

17 



with the assistance of all the boys and girls in the schools keeping their 
health rules. For keeping one rule a shingle is coloured on the roof of 
the house, and for another a brick is coloured, and for still another a 
coloured glass is put in the window. 

We began in Fernie with one Faiiw's Health House in a primary room 
and now have seven. The teachers have been very much interested and 
demonstrate this by inquiring each day how many have kept the Health 
Rules the day before. 

Jean A. Dunbar. 



THE PUBLIC HEALTH NURSE AT THE FALL FAIR, KELOWNA. 

My "corner" at the Exhibtion was as much a success this year as 
formerly. The comments were different, but still complimentary. I had 
three different illustrated " Health Talks,'" "A Trip to Healthland," " The 
Story of the Fly/' and a " Comparison of Two Homes." To illustrate the 
latter, the boys of the Manual Training School made two houses, one neat 
and clean and the other in a state of dirt and disorder. A large placard 
was attached to these, asking "Which is your Home?" 

The material used to illustrate the " Fly Story " cost me little in actual 
money, but a lot of thought and work. I had six large Hies made of wax 
and dyed some excelsior brown to look like manure. I placed a fly in 
front of a manure-pile with a notice, " She has laid 1(10 eggs here." Next 
I displayed maggots (made of white birthday candles) beside a small 
manure-pile, together with some cocoons (brown jelly-bean candies). Then 
some large Hies, and a plate of food with a fly on it, a garbage-tin (a 
baking-powder can) with garbage slopping over the top and the lid half 
on with a fly on the edge. The last illustration of all and one that at- 
tracted much attention was that of a doll in bed, representing a sick 
person with a fly in the room. 

The ''Trip to Healthland" was much harder to handle, but the cost 
was small and it made a pretty and interesting display. For grass I 
dyed excelsior green. 

M R. McClung. 



FALL FAIR EXHIBITS 

The Cowichan Leader'* report of the Cowichan Fall Fair held at Dun- 
can, September 10th and 20th, 1025, included the following: — 

" Hcaltlb Centre Work. — In the hall was placed a neat exhibit ar- 
ranged In- the Health Centre nurses, Miss I. M. Jeffares and Miss E. S. 
Naden. 

" While simple in design, it presented a clear conception of the wide 
scope of Health Centre work and was intended to correct the idea in the 
minds of not a few people that the work of the centre is confined to 
school nursing or some other limited branch of effort. 

"A placard, ' Generalized Public Health Nursing,' defined in one cap- 
tion the mission of the organization. In amplification the figure of a 

18 



diminutive nurse was placed upon a table and from this ran tiny bine 
streamers to various points on the background, where other placards set 
forth the various phases of Health Centre activities: School-work, clas>s 
instruction in first aid and home nursing, social service visiting;, tuber- 
culosis visiting, bedside nursing, and child-welfare. 

" Posters and health-booksi entered by contestants in the competition 
for rural school children in the district conducted some time ago by the 
Health Centre were also displayed, while literature on various topics was 
on hand for distribution." 

The above excerpt from the Leader and the accompanying picture will 
give any one interested an idea of the exhibit displayed by the Cowichan 

COWIEHAN HEALTH CENTRE 




5 m . Sm ,c/ wmwm pibuc turn msm "ouku^ 

Schoul Wo/?k Bedside /Vws/m 



Class 'ismi/crw. "'■/// 

V/s/r//ve 



\ s, >• 




A SECTION OP THE HEALTH CENTRE EXHIBIT AT THE COWICHAN 

FALL FAIR, DUNCAN, V.I. 

Health Centre at both Cobble Hill and Cowichan Fall Fairs. When we 
were first asked to prepare an exhibit for these fairs it seemed impossible, 
as our funds for such a purpose are almost ml. However, after some 
consideration, we decided to exhibit the posters and books sent in by the 
boys and girls of the rural schools in the " Good Health Competition " 
held last term. We accordingly prepared a sign, " Good Health Competi- 
tion," and under this grouped the posters and health-books. As the 
majority of the poster prizes had been won by Cobble Hill boys and girls, 
we arranged one complete section of the exhibit at that particular fair 
with their work only, placing in the centre a sign reading, '-The work in 
this section was done by the boys and girls of Cobble Hill." This special 

10 



attention and display greatly pleased the children as well as the parents 
of the district. 

At both fairs we were congratulated on our exhibit and have the 
satisfaction of knowing that very few attended without paying a visit to 
the Health Centre exhibit, many being sufficiently interested to return 
bringing their friends. 



VICTORIA, B.C. : 
Printed by Chablks F. Banfield, Printer to the King's Must Excellent Majesty. 



400-320-3926. 

20 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 APRIL, 1927 No. 4 



T"HE Public Health Nurses' movement in British Columbia bears out 
the saying " Nothing succeeds so well as success." At the end of 
four years' experience many mistakes can be seen by retrospection, but 
one outstanding feature of the system is its success, as evidenced by the 
adoption of the policy in so many districts of the Province. 

That success has been dependent upon three factors — the trained 
nurses, the interested public, and the Provincial Board of Health. With- 
out the help of any one of these three factors failure is almost certain. 

Naturally The system centres around the nurses engaged in the work. 
The value of the services of each nurse depends primarily upon her 
fitness, physically, mentally, and by training. Having these considera- 
tions in mind, it can be seen that only by experience can it be determined 
whether a nurse is suitable for the work. 

Every new recruit must commence work somewhere, just as school- 
teachers have to do. The public can assist in making a success or a 
failure of a nurse in her first held. Sympathy and co-operation may 
accomplish the former, whilst only a strong character can withstand 
unwarranted criticism and opposition. 

From a disinterested view-point the Provincial Board of Health can 
sense where a nurse has been remiss in her duty. It can also see from 
reports or representations where she has not been accorded full support 
by the voluntary organizations with which she has to co-operate in her 
work. 

Under such circumstances a change may be beneficial both to the nurse 
and the district without any reflection being cast on either party to the 
nursing contract. Sometimes it is felt when a change is made that the 
nurse has not been a " success,'' but in reality the district may have 
lacked that quality which it later acquires through experience, just as 
the nurse gains her experience. 

The existence of a Public Health Nursing system is an acknowledg- 
ment, however imperfect it may be, that health of the general public is 
a concern of the community as well as of the individual whose economic 
value is impaired by physical defect or organic disorder. 

The papers we publish in this number are of exceptional interest, 
and on perusal the nurses, more than any one else, will be conscious of 
the greater interest (hat is being shown by themselves in the discharge 
of their duties 

The Provincial Board of Health believes that the Bulletin as a 
barometer indicates fair weather and substantial progress for the future. 
Miss Jeffares, of Duncan, has again and very acceptably acted as Editor. 



THE UNIVERSITY OF BRITISH COLUMBIA, 
Vancouver, B.C. 

Department of Nursing and Health, 

April 2nd, L927. 
Br. H. /;. Young, 

Provincial Health Officer, 

Provincial Board of Health, Victoria, B.C. 

Dear Dr. Young, — I wish to thank yon for giving me the opportunity 
of contributing a short article to the Public Health Nurses' Bulletin. 
While no special subject for an article has presented itself to me, I do 
wish to express an appreciation of the splendid work which is being done 
by the members of the Provincial Board of Health Nursing Staff and of 
the far-reaching aims of the Provincial Board of Health itself. 

While the programme of governmental Boards of Health may be 
primarily educational, yet as education begins at birth —and, we may 
well add, before birth— -any effective health programme must commence 
with the care of the mother during the term of pregnancy and must 
include, or see that provision is made tor, adequate care at childbirth. 
That such a complete programme may be carried out in every rural 
district in British Columbia is, I know, your aim. I know, too, that 
I am expressing the opinion of the Canadian Nursing Association when 
I state that the mosl highly skilled nurses will always be found ready to 
assist in carrying out such a programme. The aim of the nursing 
profession is to provide skilled nursing service for all who are sick, 
and we realize thai it is only by such organization as that of the Pro- 
vincial Board of Health that this service can be made available in rural 
districts. Canadian nurses are proud of the development in rural public 
health service, and appreciative of the opportunity given us to carry out 
the objects for which our profession exists. 

Yours very sincerely, 

Mabel F. Gray, 

Assistant Professor of Nursing. 



TABLE OF CONTENTS. 

PAGE 

Remarks. By Dr. H. E. Young 1 

Letter op Appreciation. By .Miss M. Gray, Assistant Professor of 

Nursing, U.B.C .1 2 

Solarium. By I. M. Jeffares, R.N..... n 

Report op Progress, Esquimalt Rural Nursing Service. By Helen 

Kelly, R.N... (5 

Little Mothers' League Classes, as conducted in Saanich over a 

Period op Five Years. By Mrs. C. A. Lucas, R.N S 

Ladysmith. By S. Hewertson, R.N 12 

Health-teaching ix Armstrong Consolidated School. By P. A. 

Charlton, R.N 12 

Public-health Work ix the Kootexav Lake. By Olive M. Garrood, 

R.N.. 13 

A Clinic Babies - ' Christmas Party. By I. M. Jeffares, R.X 14 

Tin: Public Health Nurse ix Ferxie. By Jean A. Dunbar, R.N 17 

Dental Clinics. By Norman R. Carter, D.D.S IS 

Vitalizing Statistics ix Saanich. By Hilda Murray, R.N 1!) 

Coombs, Hilliers, axd Errington. By Laura I. Jukes, R.N 20 

Child-welfare Activities ix Nanaimo. By Margaret Wilson, R.N... 22 

Public-health Work ix Kamloops. By Janet Campbell, R.N... 2."> 

Breast-feedinq por the Ixpaxts op Saanich Municipality. By 

Margaret M. Griffin, R.N.... 24 

School Nursing ix Nanaimo. By Margaret E. Ken-, R.N 27 

School axd District Work ix Keremeos. By Patricia Fast, R.N 211 

Dental Service ix the Arrow Lake District. By Norman Carter, 

D.D.S... 30 

Duncan Consolidated School District. By Norah E. Armstrong, 

R.N...... I 30 




v. 



H 



O 






O 









QUEEN ALEXANDRA SOLARIUM FOR CRIPPLED 

CHILDREN. 

For two years the residents of the Cowichan Health Centre District 
have heard a great deal about a Solarium for crippled children and the 
healing-power of the sun, especially when combined with sea-breezea 
Even before it was known Thai the Solarium was to be built at Mill Ray, 
which is part of our district, funds were being raised by individuals, 
and practically every organization in the district has contributed to its 
support. When it was decided to erect the Solarium at Mill Ray we 
appreciated the fact that we were in a position to see a practical demon- 
stration of what can be done for the little cripples of British Columbia. 

A very beautiful site was chosen for the Solarium; built on a slope, 
it commands a most wonderful view of Saanich Inlet, the well-timbered 
shores blending in with the deep blue of the sea. The building itself is 
long and curved, so that as long as the sun shines its rays will find 
their way on to the wide verandah, which runs the length of the building, 
and into the long ward just off the verandah. From a nurse's critical 
standpoint the bath-rooms and wash-up rooms are a joy to behold. The 
baths are low so that the older children, crippled though they may be, 
will have no difficulty in stepping into them. Over the basins there are 
small cupboards with compartments, one for each, marked with his 
name, so there will be no danger of tiny toothbrushes, wash-cloths, etc., 
being left around or mixed up. 

The children's combined play and school room, with its low fireplace 
and many windows, is a cosy, comfortable room. Already there is a 
good-sized library of children's books, and toys may be seen scattered 
about, calling attention to the fact that while these little ones may be 
handicapped physically, their mental development is normal. Should 
any pessimist wonder whether the money spent on building and equip- 
ping the Solarium is justified, I should suggest that he take a peep into 
this room, listen to the happy voices of the children, notice the healing 
rays of the sun pouring in, and remember that ills of the body heal 
most readily when the patient is happy and contented, and 1 am sure 
he will wonder no more. 

There were nineteen children in the Solarium the day I visited it, 
two weeks after it was opened. Many were bed patients, school was in 
session for those able to attend, and those of school age confined to their 
beds were busy, in as easy a position as was permitted, on their lessons 
under the supervision of the teacher appointed to the staff. These 
children came from all parts of British Columbia, some very badly 
crippled, others to the unobservant eye not crippled at all, but in reality 
badly handicapped physically and needing the healing rays of old Sol. 

ISABELLE M. JEPFARES, R.N. 

We are reproducing photographs of the Solarium in this issue. 



ESQUIMALT RUKAL NURSING SERVICE— REPORT 

OF PROGRESS. 

The above service celebrated its seventh birthday anniversary at its 
last animal meeting. It was inaugurated in the first place through the 
machinery of the Women's Institutes, supported by a few progressive 
residents, and to-day the Association stands — a welcome establishment 
in the district, supported by five school districts in voluntary taxation. 

The service is an example of what can be accomplished by patience 
and perseverance by a small body of people striving to reach a worthy 
objective, to help in a worthy cause, and staying with it. And there is 
no worthier cause under the sun than the health of the people of a 
community. 

One has only to read the reports of the Provincial Board of Health, 
and note therein the reports of the School Medical Inspectors for the 
past few years, to realize the value of a Public Health Service to the 
community. In Hie last Provincial Report it was gratifying to note 
that in all of the five schools comprising this health district not one 
child was found suffering from malnutrition, which was decidedly not 
the case a few years ago. Despite the fact that odd cases of measles, 
scarlet fever, and chicken-pox have been found at various times through- 
out the district, there has been nothing in the nature of an epidemic in 
the health district since 1021. 

This conclusive evidence of the value of follow-up work, which permits 
of isolation of cases immediately and prevents the spread of disease, the 
realization of the value of education along health lines and the resultant 
improved health and vigour of the children, and the general value of 
expert advice to parents has resulted in the service, from being- looked 
upon as an interloper and an unnecessary expense, through the period 
of acceptance of a necessary evil — sometimes grudgingly accepted — to 
becoming a service of which the district is proud. This is evidenced by 
the type of men and women who constitute its Hoard of Council and 
officers, all of whom are keenly interested in the work and whose motto 
is " Progress." 

It is with much pleasure that I write of the splendid support given 
me by the Women's Institutes in the district, the Farmers' Institute, and 
the Boards of School Trustees. All these organizations are represented 
on the Council of the Association, thereby keeping them all intimately 
in touch with the work and bringing personal interest in the progress. 
The support I now receive and the welcome with which suggestions for 
improvement are received by the Boards of Trustees, which differ so 
greatly now from when the service was first organized, is worthy of 
comment. Before the health district was defined as it is to-day, the 
first nurse sent out here, in company with one of the officers of the Associ- 
ation, made a round of visits to the schools, seven in all. In one school 
the nurse was horrified to find on a small bench in the cloak-room a little 
old bucket containing a small amount of dirty soapy water, evidently 
used by all the children in which to wash their hands. This was reported 
to the Hoard of Trustees and the request made by the Association that 

6 



the bucket be destroyed and clean bowls and paper towels procured. 
The Chairman of the Board, an old-tinier, with a family Hearing 
middle age themselves, was very indignant. u I'll have you know," said 
he, " that my boys washed their hands in that bucket, and what was 
good enough for my boys is good enough for the others.'" Luckily, how- 
ever, younger and more progressive men were on this particular Board 
also, and the old bucket was discarded. 

Our child- welfare work starts with prenatal advice and carries on 
through pre-school years from baby-welfare and on through school-life. 
But it doesn't stop there, for we have organized health clubs and young 
people's clubs to carry on the good work. Then, through the co-opera- 
tion of the Women's Institute, one and all who make me their child- 
welfare convener, I am able to give health talks to the mothers, and by 
my home visits I am able to include all ages. 

The dental work of this Association is no longer confined to two clinics 
a year. It is continuous. We have a perfectly satisfactory arrange- 
ment with the clinic dentist, whose offices are in Victoria, to take 
children in any Saturday morning for treatment or attention. This 
does not interfere with school-work, though the clinic-work is not confined 
to school-children only. The clinic-work commences as soon as the teeth 
begin to appear. 

At the last two fall fairs held in the district space has been granted 
to the Association and a large tent erected by the committee of the 
Farmers' Institute, under whose auspices the fairs have been held. This 
tent I had tastefully decorated and had rest-chairs put in for the use of 
mothers with young children and older women who require rest. This 
rest-tent proved a real boon to those for whom it was intended. 

What I consider a very important step in the progress of the work 
is the adoption by the Council of May 2nd as Child Health Day. On 
May 2nd of this year the Association will celebrate its first annual Child 
Health Day in the form of a pageant, with health parade, etc., in which 
all the children in the five districts concerned will take part. In this 
we are confident of the support and help of the Women's Institutes in 
the district, the School Hoards and teachers, and other organizations in 
the districts. It is planned to hold a baby clinic in connection with 
this event and a review of the progress of health of the school-children. 
In the evening we hope, with the assistance of the Provincial Health 
Department, to hold a meeting for adults and young people, at which 
illustrated addresses on prevention of sickness and disease will be given. 

Helen Kelly, R.N., 

Cohrood. 



LITTLE MOTHERS' LEAGUE CLASSES AS CONDUCTED IN 
SAANICH OVEE A PERIOD OF FIVE YEARS. 

*' God took t lie blush of the morning 
And the sheen of an Orient pearl: 
lie caught the coo of the homing dove 
And the white of a lily's curl. 
Then he took the blue of the iris 
And the scent of a virgin's hair. 
And cuddled them all in His great white hand — 
Lo ! a baby nestled there." 

Are Little .Mothers' League classes necessary as part of a school-health 
programme? We cannot doubt il since we believe that school-days are 
among the most impressionable days of our life, and as, moreover, a 
public-health programme is determined by considering its bearing upon 
the general welfare of the race as a whole, and this we decide by the 
scientific study of the mortality rates and resulting economic loss to a 
country. 




EXAMINATION DAY, LITTLE MOTHER'S' LEAGUE, McKENZIE AVENI 

SAANICH, 1!>22. 



iE SCIIOOI 



Jn a study of the vital statistics from year to year, taking any country 
in the world where statistics are well kept, we always find a too high 
infant-mortality rate. The last available statistics for Canada, 1925, 
gives one to think. We lost through death at childbirth no fewer than 
1,196 mothers. This death-rate yearly seems to show an actual increase 1 . 
Still-births accounted for the loss of 8,043 infants. While even with the 
present reduction in infant mortality, Canada lost 22,310 infants, exclu- 
sive of still-births, under 1 year of age. Total losses of infant-life, there- 
fore, amounted to 30,353 babies in \ l .)'2~). It would be interesting to 
know how many of these deaths, both maternal and infant, are due to 
lack of proper prenatal care and advice. We know that this condition 
can be remedied. A considerable part of the efforts towards improving 

s 



the public health through infant-welfare activities is wasted, because we 
begin to care for om- babies from ten to twentv-five years too late. The 
proper and most efficient place to begin this care is in the public and 
private schools, when the potential mothers are elementary-school pupils. 
As Public Health Nurses, with the inestimable privilege of entering 
schools and working for and amongst the future citizens, we have an 
outstanding opportunity of helping conserve the infant-life of our country 
through the medium of the Little Mothers' League classes; the school 
is the' proper place, the Public Health Nurse the logical teacher. 

These classes should be organized in all schools where possible for 
the purpose of instructing the girls from about the seventh grade (as 
many leave before the eighth grade), and beyond, how to care for babies, 
in many sections of our communities this is particularly necessary 
because older girls are largely responsible for the feeding and care of 
younger brothers and sisters. 

In looking back over a period of five years in Saanich, we find that 
about 350 of these Little Mothers' League classes have been conducted; 
seventh and eighth grade girls in a joint class, girls of high-school age 
separately. 

This course of instruction covers a period of from ten to twelve weeks, 
with examination, which includes a written essay. Only one week's 
interval is allowed between each lesson, including the examination week. 
Badges and certificates are issued by the Department of Health. We 
usually invite some prominent person to make presentation of prizes, 
certificates, etc., at one of the school concerts. 

The course covers such things as proper feeding, bathing, clothing — 
including kind and quality of material and making of layettes — the 
proper kind of bed, the making of the bed, guarding the baby's sleep, 
with demonstration and practice with necessary articles and a life-sized 
baby doll. 

Details are given on the hygiene of the home, such as ventilation, 
lighting, and heating, (he necessity of fresh air and how if may be ob- 
tained in all seasons, guarding the baby from mosquitoes, Hies, and other 
insects. 

The general care of the baby itself is included, not only his physical 
care as we ordinarily understand it, but instruction as to how to avoid 
the formation of bad habits, and particularly concerning the necessity of 
protecting the baby from communicable diseases. 

There is no difficulty in securing the attention of the class from the 
first moment; the presence of the baby doll, clothing, bath-tub, etc., 
makes this course one of fascinating activity. In every class period 
much more time is devoted to the demonstration and practice than to the 
lecture. 

What about results in Saanich? Are they satisfactory? Have they 
come up to our expectations? Yes, we have had some results which we 
hoped for and expected, and others which were quite nnlooked for, but 
very wholesome for us as amateur teachers. The girls reproduce our 
teaching, especially in their papers, with an almost startling exactness, 

9 



and incidentally give us a sharp lesson in accuracy. So receptive are 
they indeed that at times when I have been correcting their essays and 
find myself repeated in different ways, I am humbly thankful that none 
but the eyes of a friendly colleague will scan those papers. 

Some of the good results may be summed up thus: A Little Mother 
of one of the first classes held in Saanich has just graduated with 
honours from St. Joseph's Hospital, having been inspired by the nurse 
and the love of her work in the class periods. We know of other "iris 
in Saanich who are entering the hospitals for training as a direct result 
of their experience in the Little Mothers' League. One of our girls 
enters the Jubilee Hospital in September, just wailing until she reaches 
the age standard. 

Others we find who have left school are much sought after by young 
and other mothers who are desirous of being shown the correct way to 
bathe and dress the baby. In her essay one Little Mother, age 11 years, 
•writes the following: " The most important factor in the life of the baby 
is its food." She has the whole story there. Even these results justify 
our belief in the importance of this training for our girls. 

Some of the essays are quite funny, of course, thus: One Little Mother 
in describing the bathing of the baby proceeds to tell us, " Von then take 
the baby ' by ' the neck." Still another tells us after bathing and drying 
the baby that " You must be careful not to put too much powder in the 
' crack*.' Hut they are all impressed with the mighty importance of 
proper and regular breast-fed babies. 

During the past three years it has been my privilege to examine Little 
Mothers in Victoria, Ladysmith, and Qualicum. These classes are also 
being conducted by our nurses in Xanaimo and Fernie. 

A new outline for the Little Mothers' League classes has just been 
prepared in the hope that it may he of some assistance to those nurses 
who desire to organize the classes. We recommend the outline to your 
notice with much diffidence and invite your free criticism of it, assuring 
you that any suggestion you may put forward for its improvement will 
be much appreciated. 

C. A. Lucas, R.N. 



The following essay will show the results of the teaching as conducted 
in the Little Mothers' League classes. The writer is a girl of 12 and the 
essay is her interpretation of the lessons received from the Public Health 
Nurse. Health habits have been implanted in this child. Is if not worth 
while? 

THE NURSERY. 

A baby's nursery should be perfectly clean and should not face the 
back yard. The windows should face the south because the sunlight then 
is plentiful. The reason why it should not face the back yard is because 
the windows attract the Hies, and if the windows are kept shut the flies 
crawl along the windows and make them filthy and dirty. Then if the 
windows are kept open the flies will come in and bother the baby. 

10 



The average temperature of the nursery should be 65 degrees and 00 
degrees at least. It should not exceed 60 degrees because when a baby 
is taken into the outside air after been in a warm room he will catch cold. 

The room should be properly ventilated and the windows should be 
opened every day. In the winter it is very hard to keep the windows 
open and prevent the baby from getting a cold. A good plan is to keep 
the window as wide open as possible through the day while the baby is 
in another room and to put the windows down about two hours before 
putting him to bed so that the room would warm up and then when the 
baby is in bed, raise it up slightly. Another way is to put the window 
up with a wide board. Then at the top of the window there will be an 
open space. 

The baby's bed should be only for himself because the older person 
sleeping with him may roll over him, when the older person is turning 




EXAMINATION DAY. LITTLE MOTHERS' LEAGUE, MODEL SCHOOL. 

SAANIOH, 1926. 



over it seems to fan the blankets and will give a draft and the baby will 
want to be fed too often. 

The baby should be fed from the mother's breast. God meant that 
the baby should be under the mother's food and the cow's milk is the 
calf's food. If the baby is fed by cow's milk the mother should be under 
the directions of a physician. The mother's milk takes no time to prepare 
and does not keep the mother too busy as it does when it is bottle fed. 
Bottle fed babies require about five bottles and nipples and washing them 
all through the day makes more work for the mother or nurse. It can 
be easily seen that breast babies are not as cranky as bottle fed babies, 
that is if the mother has nothing wrong with her. 

Viollete Norman, Age 12 years. 
Lady smith. 

11 



LADYSMITH. 

It is just over two years since Public Health Nursing started in 
Ladysmith and the work is gradually increasing. 

The chief problem is having no Health Committee. I am hoping to 
form one and get them interested in child-welfare and pre-school children; 
as there is not much district nursing, only amongst the trades people. 
But up to the present date I have been unfortunate, though still hoping 
they will eventually see the necessity of one. 

Health education in the schools has improved the general condition 
of the children. Some of the parents have told me of their children 
refusing to eat fried meats and canned foods because nurse said, " It was 
bad for them." 

In the rural schools, where all the water has to be carried from a well, 
I found the children were using one common drinking-cup which they 
put into the pail, and one roller lowel for Hie whole school. I explained 
to them how disease was spread and what they could do to prevent it, 
with the result that now the majority of the children have their own 
small towels and unbreakable cups. 

The teachers are showing an interest in the work by giving the 
children health posters to make during their drawing lesson. The draw- 
ing may not be perfect, but the idea is there, which is the most important. 

In the primary-rooms the children are learning to read from the health 

verses. This is a great he!]) and doubly impresses them in the correct 

habits and principles of living. „ TT 

1 S. Hewertson, R.X. 



HEALTH-TEACHING IX ARMSTRONG CONSOLIDATED 

SCHOOL. 

It is sometimes difficult to make health an interesting and vital 
subject. In the primary grades it is comparatively easy, as the wee tots 
are always keen and interested in anything new. Health is taught 
mostly by simple projects, stories, and health songs. 

Four of the junior grades have produced health plays, which they 
give at various times to the other grades and on special occasions. They 
have all had competitions in sleep, cleanliness, drinking milk, and other 
health rules. It seems to be better to take these separately and not too 
long at a time, as the children soon tire and lose interest. 

The pupils of one of the grades are keeping health-books in which 
they record their monthly weight, the health rules done, and a summary 
of their health talks. 

Grade V. has made a health-house. The foundation is beans, the walls 
are stuccoed with oatmeal, and the roof is shredded wheat, topped by 
a milk-bottle chimney. The boys made the furniture in their manual- 
training class. 

In the senior grades we have had monthly essays on a health topic. 
Some of the periods have been taken up by four-minute talks by the 
pupils, followed by a discussion. First-aid instruction is being given 
and we plan to have competitions in practical work by different teams. 

12 



The senior girls have had a course in home-nursing and care of the 
baby. They made the layette in their home-economics class. 

All the grades with exception of Grade I. have had tests periodically, 
their marks being recorded in their reports. This seems to make the 
children realize that health is as important as any other subject. 

P. Charlton. 



PUBLIC-HEALTH WORK OX THE KOOTENAY LAKE. 

September last the public-health work was reorganized on (he 
Kootenay Lake. There are nine districts and schools to be visited; 
Procter being the headquarters of the nurse in charge. Here I have a 
comfortable office where much correspondence is done and clinics are held. 

Every day the Public Health Nurse may be seen wending her way in 
the early morning to the Ian din "-stage to board the quaint paddle lake- 
boats that ply up and down the glorious Kootenay Lake; with its back- 
ground of snow-clad mountains, some towering 10,000 feet, with the tiny 
fruit-ranches nestling at their feet. Journeying up and down this lake 
is an ever-changing panorama of beauty and colour, varying from the 
vivid hues of the sunrise to the delicate pastel shades when the sun dips 
the western horizon. Life is not all 1 ravelling with this vista of beauty, 
it also includes walking many miles daily to the various schools and 
centres. 

Transportation is not an easy matter in the secluded western settle- 
ments, especially when one ploughs through the unbroken snow-tracks. 
In spite of many difficulties life is full of interest. 

We have arranged, with the kind assistance of our Health Department, 
through Dr. Young, weekly dental clinics which are held in Nelson. The 
Department is paying 50 per cent, of each child's account. This is much 
appreciated by the parents, now we are slowly and surely getting their 
teeth attended to. Health chores are tilled in daily by all children and 
buttons given to those procuring the most marks. Hot cocoa is being 
served in many schools for lunch. Paper towels and individual cups are 
being provided. These new ideas all take time and patience to procure. 
Health posters and books are made by the junior classes. 

To the little people I read nature stories, also " The Cradle Ship." 
This is a delightful nature-book telling of the mother, father, and baby 
life of all trees, flowers, plants, bees, birds, animals, etc., and, lastly, the 
most beautiful of all, the human baby. It is most wonderfully written 
by " Edith Howes," of New Zealand. Little Mothers' League classes have 
been formed for the C.G.I.T. Group of Procter. Mrs. Kinney, our Secre- 
tary, is keenly interested in this movement. Then, too, there are the 
baby and preschool age clinics, which were held monthly until the snow 
came. They will shortly be resumed. 

All schools are visited fortnightly. The children are weighed monthly, 
which is the delight of them all, especially now we have our own conti- 
mental scales, which traced with me where'er 1 go. At the beginning 
of September I was surprised to find that 02 per cent, of the children 

13 



were underweight. Some as much as II) and \'2 lb. below normal. After 
constant talks on food values and much encouragement by the school- 
teachers and myself, the percentage has been reduced 40.5 per cent. This 
is most gratifying and shows that the children and parents are realizing 
the importance of health. One boy was \'2 lb. underweight and had very 
septic tonsils. After they were removed he went straight ahead and 
gained (> lb. one month. lie is now 1 lb. overweight and looking in the 
pink of health and happiness. Most of the children I found on very 
unbalanced diets. After introducing cod-liver oil and more milk daily, 
etc., into their diet, I have been rewarded. It is hard to understand that 
people do not realize that health is their birthright and inheritance. 
When one is sick, it is just cause and effect all the time. Health talks 
on various subjects arc given at each visit and a good watch kept on 
tonsils and teeth. 

Many mothers have greatly felt the benefit from the methods of Sir 
Truby King (of New Zealand). His ideas of re-establishing the mother's 
milk supply and test foods for breast-fed babies has been much appreci- 
ated. Then, too, his humanized milk recipes have been used with their 
usual success. 

The Women's Institutes have been helpful in many ways. I have 
spoken at several of their meetings, of my work and the value of health 
and prevention of disease, etc. 

I would like to say one word of the help and support I have received 
from all of the Nelson doctors. They are a pleasure to work with. 
Never once have I fell they have had anything but the most friendly 
feelings toward our work. The school-teachers also, with one exception, 
have been of the greatest assistance. One looks forward with great 
pleasure to Hie school visits, always such happy smiling faces greet one. 

Although pioneering-work is very hard, it is certainly most gratifying 
to see one's work slowly and surely growing. Many are the difficulties 
one experiences. The greatest, I think, is the lack of understanding and 
consideration in small things that mean so much to one trying to lead 
people to health, happiness, and prosperity. 

Oh, that we all had the understanding heart of Thomas Bracken (New 

Zealand) : — 

God ! that men would sec a little clearer 

Or judge less harshly where they cannot see: 
O God! that men would draw a little nearer 
To one another! They'd lie nearer Thee — 

And understood. 

Olive M. Garrood, R.N. 



A CLINIC BABIES' CHRISTMAS PARTY. 

The Tuesday before Christmas was a gala-day at the Cowichan Health 
Centre, for on that day the nurses were "At Home" to all their little 
clinic friends, and in spite of very cold frosty weather the babies and 
their mothers arrived in time. A week before the day set for the party 

14 







X 



X 



x 

H 



tiny invitation cards. decorated with Christmas seals were sent out to all 
the babies who attend the well-baby clinic regularly. Long before that 
time, however, the staff had been busy, as it was decided to have a 
Christinas tree and all the trimmings. 

Sharp at 2.'M) in the afternoon the first of the invited guests arrived 
and from then on there was a steady stream. Our front walk and 
verandah made an ideal parking-space for perambulators and the motor- 
cars were lined up along both sides of the street. The Corporal of the 
Provincial Police, whose children were a little too big to be invited to 
the party, came over to ask if he could come to the party himself, as he 
considered it necessary to put a special traffic-man on duty to handle the 
perambulators as well as the motor traffic. The Health Centre Avas 
indeed having a busy time. Tea, and a very delicious one too, provided 
by our committee was served to some forty adults, and of course there 
were more than that number of infants. While the mothers were enjoy- 
ing their tea a blanket was spread over the rug in the living-room, the 
fire-guard put in place, and there before the log fire a number of the 
babies besported themselves. 

The runabouts were entertained with milk and biscuits and had a 
lovely time running all over the Health Centre. If had been thought 
that perhaps these young guests would like to play games and one of the 
large bedrooms had been prepared for this purpose, but they much 
preferred amusing themselves in the company of their mothers and baby 
brothers and sisters. 

After tea came the Christinas tree, and very pretty it looked all 
covered with frost and tinsel and lit with tiny electric bulbs. The Health 
Centre Office was the setting for this scene, as with double doors into 
another room it provided very nearly sufficient room for all the mothers 
and kiddies to be seated. We did not provide a Santa Clans, as consider- 
ing the age of our guests we deemed if wise not to run a chance of 
frightening any one, and instead had the Health Officer's little daughter, 
a very pretty fairy-like little girl of 5, distribute the gifts. There was 
a tiny little toy for every little guest and oranges and candy for the 
older ones. 

As is usual with " baby " parties, it broke np early, so that " Mother y 
could get home in plenty of time to prepare " Daddie's " snpper, but not 
before one and all had expressed their pleasure and enjoyment of the 
" Nurses' " party. 

As for the nurses, did they enjoy the party? Of course they did; 
in the first place, it was really in the nature of a house-warming, for 
although we had been living in our present quarters for six weeks it was 
our initial party. Then, too, who would not enjoy preparing for such 
a party, procuring and decorating the tree, wrapping up all the little 
parcels, and deciding what each tiny guest was to receive. Also isn't it 
nice to remember that a great many of our babies saw their first Christ- 
mas tree at the Health Centre. 

In order not to forget the country babies who were unable to get into 
the party, we sent Christinas greeting cards to all the babies in the 

10 



district who are visited regularly by the nurses, and of wlioni we have 
about 250 on our records. There are a few not quite as fortunate as 
some of the others, who received a parcel from the nurses in order that 
Santa Clans might be assisted a little and might not be tempted to pass 
any one by. 

it would be rather hard to say who enjoyed the party the most, the 
babies or the nurses; and as for the clinic babies' mothers — well, any 
one looking in a window would simply say, " They all appear to be well 
and very happy," and so thev were. , ., , ,, ,, 

1 '• ' ' LSABELLE M. JEFFARES, R.JN. 



THE PUBLIC HEALTH NURSE IX FERNIE. 

This being my second year of public-health work in Fernie, I am 
pleased to report considerable progress, especially among the school- 
children. 

Although it is sometimes very uphill work, and one is apt to think, 
w> What is the use of increasing the service," as each new advance is looked 
on by some one as being unnecessary, and one may hear the remark that 
"it has never been done before; why is it necessary now?" — still the 
majority do appreciate the work done. 

As I have said in my previous article, the majority of the population 
of the district are miners and of mixed nationalities. It is regrettable 
to have to state that the foreigners are much cleaner in their homes than 
a certain class of English-speaking residents. 

We have had a very severe winter this year; in fact, at the time I 
write this article the schools have been closed two days on account of 
the snow-storm. It is almost impossible to gel about; the snow-plough 
goes along most of the main streets, but np here where 1 live the snow 
is too dee]) for the horses to get the plough through, so we have men 
digging a path to the more cleared roads. 

Since the cold weather began we turned an empty class-room into a 
lunch-room for the children who live some distance from school. They 
bring their lunch to school and I make cocoa each day, and the teacher 
on duty at the lunch hour serves it. Sometimes we have only thirty, 
but have had ninety-two, depending on the severity of the weather. 

When this service commenced the principal said to me, " It's not much 
use making them wash their hands at school before they eat; they have 
never done it in their life." However, I insisted that they should do so, 
and now, as a matter of course, the teacher asks of them as they come in, 
" Have yon washed your hands? " And they never think of sitting down 
to lunch without having done so. 

The lesson I last talked on to the children happened to be on " The 
Way Germs enter the Body," so I was able to emphasize why it was so 
important to wash hands before eating. 

Last year in ten junior grade rooms we had a Health Fairy's House, 
which each class completed; this year we have a race-track leading to 
the Fairy's house, with stations all along the route, each station represent- 
ing one of the health rules. Each class has a small motor-car made of 

17 



cardboard covered with pictures of vegetables and fruit; on either side 
the track runs a fence, each post of which represents 4 miles. Every 
day the teacher moves the car along so many spaces, according- as the 
class keeps the health rules. It is very gratifying to notice the improve- 
ment in the children's teeth since they began these health competitions, 
and it is quite the usual thing, on visiting the homes, to be told the 
children refuse to drink anything but milk or cocoa, and the mothers 
say they all insist on having vegetables as they have to keep the health 
rules. 

The older children this year have health-books, just an exercise-book 
with the health rules pasted on the front page. I got the principal to 
type them for me; they rule out a page each month, leaving a space for 
each day of the month, and daily till in an " x " for the rules kept. 

The best girl and boy in each class who keeps all the rules is allowed 
to wear a red badge, as in the Health Crusaders. We have Little Mothers' 
League classes this year, two a week with an enrolment of fifty-two 
pupils; the girls seem very interested and we hope to have an examina- 
tion at the end of the course. The matron of the hospital here has 
promised to officiate at the examination, when I hope quite a number of 

the girls will receive certificates. , . _ 

Jean A. Dunbar, R.N. 



DENTAL CLINICS. 



Is the district appreciative of the rural dental clinic arranged for their 
school-children? Ves, indeed, especially in the outlying, isolated schools. 
There the dentist's visit was unprecedented; a meeting was held in places 
to consider acceptance of the Health Department's offer; his local 
expenses were to be paid. There were responsibilities to shoulder; a 
place for the clinic to be arranged for. 

Result: Discussion, interest taken in a very general manner in our 
coming and going and conduct while there, and 100 per cent, in nearly 
all schools cared for. 

Here in town the School Board members accepted with enthusiasm. 
The dentist, however, is a regular institution ; his warnings and admoni- 
tions old stuff and believed by some to be mercenary. The clinic was 
held in his office; there were no local expenses to be paid. The coming 
and going of the children was not unusual, the citizens familiar with 
Government aid to hospitals, aged, etc. 

Result: Interest taken is by individuals who are largely in the habit 
of attending a dentist, anyway; the children needing the clinic most 
being those who did not avail themselves of it. 

The general public is appreciative. We have every reason to feel 
enthused over the way this introductory work has been received. 

The great truths of health are but slowly assimilated, and we save 
the teeth in health to-day primarily for the sake of the general health. 

Norman R. Carter, D.D.S. 
Nakusp, B.C., April 1st, 1927. 

is 



VITALIZING STATISTICS IX SAANICH. 

What at one time was just a daily record sheet, compiled day by day 
and totalled at the month and year end, respectively, has in these days 
of generalized Public Health Nursing come to be recognized as that 
very essential part of our work, statistics. 

Perhaps it might be well at this stage to explain that I am prompted 
in writing by our utter inability to give rise to any discussion following 
Dr. Hill's lecture to us at the Refresher Course last year. Dr. Hill spoke 
of " vitalizing statistics," and I thought that it might interest you to 
know of one or two instances through which I have had an opportunity of 
seeing statistics " come to life." 

Among my first impressions at the Saanich Health Centre was the 
amount of stress and importance laid upon the necessity for keeping 
accurate and detailed records; in fact, I think all who have spent any 
time within its walls will have realized this. 

These records, issued by the Department of Health, which have been 
kept for the past five years, were introduced into Saanich by Mrs. C. 
Lucas, the present Nurse Superintendent, who is an enthusiastic statis- 
tician. 

Last year one of the Saanich schools was burned to the ground and 
everything was destroyed, including the medical cards which contained 
that and previous years' health records. The system of keeping statistics 
at the Health Centre aims at having a complete record of every child 
from birth and includes a permanent school-card for every pupil, and 
each year the doctor's findings are transferred from the school-card to 
this sheet. So you can see it was only a matter of time to have new 
school-cards copied from the office records. 

Another example occurred just a few days ago in relation to one 
pre-school child, in a large family of schoolchildren, who developed 
chicken-pox. When asked over the phone if the other children had had 
the disease, the mother said, " Yes-, she thought they had." Now about 
four years ago small questionnaires were sent out from the Health Centre 
to all parents of schoolchildren in Saanich, approximately '2,'2'2'2, asking 
particulars) as to infectious disease, vaccination, tuberculosis, etc.; these 
to be filled in, signed by both parents, and returned to the Centre, where 
they are kept up to date. The fact that this mother only thought that 
the children had had the disease caused us to refer to the slips mentioned, 
and there we found that no member of the family had ever had chicken- 
pox. 

It is this method that kept Saanich "a free from infectious disease" 
municipality, and it is easy to see, from the case cited, the result of 
sending four children from an infected home into different class-rooms 
of a school with over 200 children. The mother evidently saw no harm 
in telling an untruth to avoid having to keep her children home from 
school, until the nurse had explained to her the amount of harm which 
might be done. 

There was a chance to prove how statistics could help us to get over 
to at least that one family that first principle of public health — namely, 

19 



the prevention and spread of communicable diseases — and is a clear case 

of vitalization of statistics. 

Hilda Murray, K.N., 

tf (HiiiicJt Heal tit Centre. 



COOMBS, HILLIERS, AND ERRIXGTOX. 

Generalized Public Health Nursing covers such a wide area that one 
hardly knows just where to begin in order lo give an idea of the work 
that is being carried on in a rural district. I think it is because of this 
huge scope that so many nurses are deserting the hospitals for this 
broader interest. In no other held of work is a nurse so completely 
thrown on her own resources, and while difficult situations sometimes 
arise, they are stimulating and serve as an impetus to go on when these 
difficulties have been met successfully. 

From bedside nursing to the educational side of nursing — i.e., in the 
schools— is a greai change and keeps 0m 1 up in the theoretical side, as 
the little talks, however simple, have to be planned out carefully before- 
hand, even if ii is only explaining one of the health rules, such as washing 
the hands carefully before touching food. And, by the way, since coming 
to the country (being city-bred) I realize how much it means in the 
country districts, this washing of hands and taking of baths. In the city 
all 0m 1 has to do is turn on a tap, and presto! lovely hot water Hows out 
merrily, making this part of the toilet a delight. Not so in the rural 
districts. All water must be carried in from some distance from the 
house and then healed on the stove, making bathing and washing a very 
tedious process indeed. This last summer many wells went dry in this 
district and it meant walking lo one's neighbours, perhaps a quarter of 
a mile distant, for a very precious bucketful. So you may imagine how 
very much I appreciate the children's interest and co-operation when, 
al one particular school, whenever I appear, each child presents a pair 
of well-scrubbed hands. The teacher tells me the nurse is responsible 
for the drying-up of the wells. 

I have a great incentive to this side of the work in the interest of the 
teachers. This, of course, is half the battle. A few months ago 1 sent 
lo Colgate's & Co., Montreal, for sample tubes of dentifrice, and I have 
to thank them for their very liberal response to my request. Each school- 
child received a tube 1 of tooth-paste, and many parents tell me that the 
teeth have been scrubbed religiously ever since. In the box also was 
dental literature to be distributed. It is very encouraging to find such 
liberal co-operation. Our next important work is to find a dentist who 
would be willing to come to this district to do the children's teeth. We 
are 30 miles away from a dentist and for many families there is no way 
of transportation. If there is a dentist looking for a holiday in a beauti- 
ful part of Vancouver Island, with a little work thrown in, we could 
promise him plenty to do. There is a crying need here for dental atten- 
tion. I always lay greai stress on this part of public-health work because 
so few people realize the importance of mouth hygiene. It is the founda- 
tion-stone of prevention. 

20 




y< 



c 
y< 



o 









Ill December we had our last lecture in the Little Mothers' League 
classes, and to mark the occasion for those receiving diplomas we arranged 
a little evening party, at which Mrs. C. A. Lucas very kindly officiated, 
giving out the diplomas and prizes. In these classes girls ranging from 
12 years and upwards learn the care and handling of a baby. We have a 
life-size celluloid doll which does for our baby and which has a complete 
layette. All the Little Mothers love bathing and dressing it. The Little 
Mothers' League was formed to do away with ignorant mothers in the 
future, and also that the older children can be a help in the home. 

We are planning at present to give a health play at Easter. The 
rehearsing of this play has caused the children much pleasure, and from 
results already seen has instilled in them the very valuable lessons 
which every line of it contains. In fact, I think most health-teachers 
will agree with me that this entertaining and comprehensive way of 
presenting truths to them is absolutely invaluable. 

From what I have tried to show of our work in the country, you will 
see that not only is the daily round an interesting one, but we also have 
the satisfaction of knowing that through our endeavours we are helping 
to build a healthier and therefore happier generation of Canadians. 

Laura I. Jukes, K.N. 



CHILI )- W E LFAKE A( T I V I TIES, NANA [MO. 

Recently at a public meeting in the city a splendid address on " Child- 
welfare " was given by a very noted speaker. Among those who attended 
the meeting were representatives of all the most active organizations, 
not only of the city, but of the surrounding districts as well. 

The address made a very great impression upon the audience. Until 
then few had realized the importance of this great work; how far-reach- 
ing its possibilities; how it affects the nation's health, it is as the 
speaker said — the responsibility does not entirely belong to the Govern- 
ment, but to every individual citizen. Continued lectures and educa- 
tional propaganda will not become effective until it is substantially 
backed by sympathetic concentrated action in the community. 

When you take into consideration a city with a population of approxi- 
mately 8,800, having a birth-rate of 39 per 1,(100 population per year, and 
add to this a Public Health Committee intensely interested in child- 
welfare, it can readily be understood why it was resolved that a well-baby 
clinic would be a splendid asset to the community. 

Arrangements for this venture were speedily made, and on July 6th, 
1020, the well-baby clinic was declared officially open, Dr. Ross Lane, 
President of the local Medical Association, attending in an advisory 
capacity. 

The clinic was at first held monthly, but on making child-welfare 
visits to the homes it was found a few of the mothers had been unable 
to attend regularly because it had not been convenient, and so had taken 
baby to a near-by drug-store to be weighed. While this was very good 

22 



and showed that interest in weight had been aroused, it also showed that 
the time must be made more convenient for the mothers, and so it was 
definitely decided to hold a clinic weekly, on Tuesday afternoon, beginning 
at 2 p.m. This we continue to do, and new babies are enrolled weekly, 
proving that interest is keen, and we must keep it so, because it is through 
our baby clinics the defects which are beginning are pointed out to the 
mother, advice is given, and then they are urged to consult their family 
physician in order that these defects may be corrected. 

Many little difficulties appear to arise at intervals in connection with 
the work, as, for instance, when the time was changed from monthly to 
weekly clinics, it was thought the usual cup of tea need not be served. 
However, a very few weeks showed this to be something of importance 
as it held the group of mothers together and enabled them to meet and 
talk with each other about their little problems. Many mothers have 
told how much they appreciate the opportunity thus given them. 

Another question arose : Was it asking too much of the Medical 
Association to expect them to continue sending a man weekly? Or would 
it be better to arrange 'to have the doctor in attendance once a month, 
and on intervening clinic-days to have him " on call," should any case 
present itself whom nurse thought should have his supervision? An 
interview with the secretary of the association very soon showed there 
was no question about attendance at the clinics. The matter had been 
thoroughly discussed at a meeting of the association previously, and the 
medical men had then stated their willingness to attend, and were in 
fact interested in the work. This, the secretary pointed out, had been 
proved in the past by their attendance and support at the clinics. 

The problem of baby-scales was in the beginning solved for a time 
through the co-operation of a local druggist, who very kindly loaned us, 
each week, the scales from his store. Now, however, we have at the clinic a 
lovely new " baby-scale," presented by the girls of the Malaspina Chapter, 
I.O.D.E. 

It is too soon to speak of or quote statistics; our work has just begun, 
but the results so far can be judged by the support and interest shown 
throughout the community. 

Margaret Wilson, 

Public Health Nurse. 



PUBLIC-HEALTH WORK IN KAMLOOPS. 

When I received the letter from the Provincial Health Department 
asking for something that might be interesting or helpful for the 
Bulletin, I felt at first rather at a loss until I thought, " Why, every 
one seems to be working towards the same objective, though through 
different avenues" — namely, a healthy foundation for the children. 

The children themselves are taking a great interest in their health 
programme, and this I feel sure is due to the interesting way the teachers 
have of presenting this particular phase of the curriculum to them, 
especially in the lower and intermediate grades. 

2:5 



Turning to the home, the co-operation from the parents is good and 
steadily improving. More cereals and vegetables are being used and a 
greater interest taken in the children's teeth, but in the matter of getting 
sufficient rest there is still much to be desired. 

Quite a number of excellent ideas have been developed from the Dairy 
Council literature which was provided by the Provincial Health Depart- 
ment. One of the primary-grade teachers mimeographed the riddles, one 
for each child. The children are required to print the answers and also 
colour the accompanying picture, so the health lesson is correlated with 
other parts of their work. 

At the Thompson Valley Teachers' Convention, held January 3rd and 
4th, hygiene was given a prominent part on the programme. 

Dr. Wyinan, from the University of British Columbia, gave two most 
interesting addresses on child-behaviour problems and later addressed 
the Rotary Club along the same lines. 

.Miss Jones, from Vancouver Normal, gave an interesting demonstra- 
tion lesson on physical drill and also an address on hygiene, which I was 
exceedingly sorry to miss. 

At the end of the school term last summer the Rotary Club made it 
possible for the first time to have a girls' camp. The camp was called 
{ Canandaigua," which means the Cam]) by the Lake, and we had fifty 
girls there for twelve days. 

The Rotary Club not only built the cook-house, but provided free 
transportation by auto (50 miles) both ways and afterwards broke cam]). 

While at cam]) we tried to foster good health habits, friendship, team- 
work, kindness, and helpfulness, through physical drill, bathing, hikes, 
basket-work, and cam]) tires. The girls seemed to enjoy the life and 
another cam]) is being planned for this year. 

The Red Cross well-baby clinic is {(laying a most valuable part in the 
health programme and through it we are laying the nucleus of a pre- 
school clinic. 

During an epidemic of scarlet fever, out of forty-five cases only 
nineteen developed in school. This is chiefly accounted for by the close 
observation of the teachers and the carrying-out of the Medical Health 
Officer's order that no child absent from school for one day could return 
without a medical certificate. 

Though perhaps nothing spectacular is being carried on, we have all 

the same aim in view — a good foundation with a thorough understanding 

of the essentials to build with. , ., „ „ 

Janet ( ampbell, K.N. 



BREAST-FEEDING FOR THE INFANTS OF SAANIOH 

MUNICIPALITY. 

" I haven't enough milk; I never could nurse my babies; the women 
in my family never could." With some such statement the mother thinks 
to summarily dismiss all ideas the nurse may have that her baby will be 
breast-fed, and in all probability this same mother really believes that it 

24 








'A 

'A 



isn't possible. " When I got up after being confined, my milk just went." 
Where and how did it go? 

When we graduate from hospital we know the normal and natural 
thing is for a mother to nurse her baby. We also know that if a baby 
does not seem satisfied a supplementary feeding must be given. Some 
mother hasn't apparently any milk, but do we realize that even the tiniest 
drop will do much towards starting her wee mite on the right path? 
Do we further realize the importance of putting the babe to the breast 
regularly for the purpose of increasing the secretion of the milk, and 
that " expression " will help so that the baby can be entirely nursed from 
the breast? I think not; at least J for one did not know, nor did many 
of my colleagues from my own and other training-schools with whom 
1 have discussed this matter. 

Though, during my now nearly three years at the Saanich Health 
Centre, " re-establishing breast-feeding by technique of expression ' is 
a subject which has been frequently brought up for discussion by our 
Superintendent, a subject which I knew nothing about heretofore; I 
didn't realize what wonderful results could be obtained until a year ago 
when I left the school-work in which I had been more or less specializing. 
Since then it has been my privilege to help combat to some extent the 
ever-increasing tendency for bottle-fed babies. 

I take every opportunity that presents itself with an expectant mother 
who has an older baby which has been bottle-fed, sympathize with her 
because of her misfortune in not nursing her last, and prepare her mind 
for the opportunity to nurse her next baby. As early in the prenatal 
period as she is reached, we start preparing her mind and plan with her 
for the breast-feeding. Of course she will nurse her baby! This one 
will be different from every other — her own or any one else's! Helping 
create an optimistic attitude is of great importance. Many mothers who 
did not know the importance of regularity are gradually coming to 
realize how much this most important factor means to the infant's 
digestive system and general welfare, as well as being able to get a good 
night's rest themselves and do their housework unhindered by a sickly 
or hungry babe for ever crying. During the early period when the milk 
first conies in, often the little one does not require all that is supplied; 
the breasts are not completely emptied ; they secrete less and less milk as a 
result, and later on the supply is not sufficient. By means of " expres- 
sion," which is so easily taught that the mother may do it herself, this 
supply can be kept up, each breast being completely emptied after each 
and every nursing. 

It is curious to note that what we have come to realize as of first 
importance in an "up-to-date scientific method" in reality dates back 
probably from the beginning of time. If we ask any farmer how he 
keeps up the supply of milk, he won't say by means of "expression,'' 
but he will say by persistent " stripping," which is the same thing — the 
emptying of the breasts. If the farmer considers it necessary to not 
only watch the clock most carefully so as to be sure the milking will 
not be ten minutes overdue, but to empty the udder to the very last drop, 

20 



how much more important for us to do the same tiling for our human 
babies, the future citizens and perpetuators of our race. 

Of frequent occurrence is the mother we meet who started baby on 
the breast; either the supply was too scanty or baby was cross and 
fretful. She phoned a neighbour who had a big overly fat babe to ask 
how she fed hers — canned milk was the order of the day, so she did like- 
wise. One case in particular I should like to cite. Mrs. had been 

confined in hospital. Getting the names of all babes registered in our 
district from the Vital Statistics Department, this is one of the homes 
I went into. " You have a new baby; I came to see if I could be of 
any assistance''; and that introduction was sufficient. I found that her 
milk came in all right, but by the end of a week had apparently all gone 
again. Her babe was put on canned milk and I didn't reach her until 
two weeks after she came home, three weeks since breast-feeding had been 
discontinued. She was so surprised when I told her breast-feeding could 
be re-established. "What! after all this time?" I instructed her to 
put the babe regularly to the breast whether it seemed to get anything 
or not, and have a cow's milk supplementary feeding ready; also did 
the " expression ' myself, teaching her in a practical way, with the 
promise to go in the next day. " My neighbour says that instead of baby 
just keeping me awake all night, with combination of breast and bottle 
it won't ever sleep, and I'll kill it," greeted me on my return visit. Never- 
theless, she was ashamed to admit she hadn't attempted to carry out my 
instructions because of her neighbour's criticism, and decided to try my 
plan. A visit daily for a week, and the mother informed me that baby 
was gaining well and required only two-thirds as much from the bottle.. 
With constant supervision and encouragement, by the end of three weeks 
her babe was entirely on the breast ; the mother had lost her " nerves ,; 
and was getting proper rest. This is only one of many cases which we 
have on record at the Health Centre and who have been helped in this 
way during the past live years. Some that "can't be bothered" will 
nurse their babies, because with the nurse going in regularly they are 
ashamed to say they won't. 

" Better to erect a fence at the top of a precipice than to maintain 

an ambulance at the bottom." ., ,, _. 

Margaret M. Griffin, R.X. 



SCHOOL NURSING IX NANA I MO. 

Besides the usual routine duties in connection with the school pro- 
gramme, we have taken a very active part in the various entertainments 
fostered by the school as a whole. 

Last December, at the annual school concert, thirty girls of the Little 
Mothers' League presented the short two-act health play, "From Danger 
Valley to Safety Mill," by Lydia J. Roberts. It was very enthusiastically 
received and of distinct educational value along health lines. 

A rather amusing situation was created when the curtain dropped at 
the end of the first scene. The audience apparently concluded the pro- 



gramme was finished and rose in a body and commenced filing out. Con- 
sternation reigned among the actors until the audience was persuaded 
to return to their seats. 

In February the various grades of our school staged a demonstration 
of project-work. We made a reproduction of the " Bird's-eye Map of 
Healthland " on an 8- by 12-foot scale. Real trains ran on real tracks on 
real gravel road-beds through mountains of moss and rock. The accom- 
panying snapshot will give a small idea of what our exhibit looked like. 

A contest of health booklets, posters, and essays is being conducted 
just now, terminating April 15th. The Provincial Department of Health 
is awarding prizes. We hope to have some of the work on exhibition at 
the Refresher Course. 




BIRD'S-EYE VIEW OK II K ALT 1 1 LAND. NANAIMO. 



At the suggestion of the Supervising Principal, a survey was made to 
determine the relation between the health of the child and his accelera- 
tions in school. The following is a very brief summary of our findings: — 

Total accelerations 264 

Accelerated once 161 

Accelerated twice ----- — <»2 

Accelerated three times 36 

Accelerated four times 5 

Normal in everv respect.. ~ - 148/ — ,.,, 

}=1 i.W/( 

No defects, but underweight ~ ~~ 57 y 

Defects — tonsils, teeth, vision 59 

Underweights, with defects 44=74.5$ 

Total number of underweights..... 101=38.2$ 

The average percentage of underweights 

for the school as a whole is 51.9$ 

Two or more accelerations 103 

There are IS with defects 17.4$ 

and 41 underweight .... 39.8% 

28 



Our conclusions from this data are that, far from seriously affecting 

the physical condition of the children by being- pushed ahead more 

rapidly, those accelerated are the healthiest and for the most part 

better nourished. It would be interesting- to compare these figures with 

those from other schools. , r „ ,, T> ^ T 

Margaret E. Kerr, R.N. 



SCHOOL AND DISTRICT NURSE, KEREMEOS. 

It often seems hard to believe that so much can take place in a space 
of a few years. Before I went in training most of my life was spent in 
outdoor work and as the hours flew by I dreamed many things. One of 
these was to become a nurse and go about doing good, helping people 
who were in trouble, etc. When our community first had a District 
Nurse I used to envy her unendingly and think of the wonderful oppor- 
tunities she had for doing good. As soon as possible I trained at the 
V.G.H., the Public Health Course at Saanich Health Centre, and came 
back to mv community to do Public Health Nursing. 1 find it is not 
quite so simple, and, try as I may, I cannot recognize in myself the 
District Nurse of my dreams. I always liked the people here, which 
was one of my incentives for coming back to them, but since I've been 
working among them I appreciate them more than ever. 

Before leaving the Coast I was talking to a prominent doctor, who 
stated that he considered it a pity to do District Nursing, where what 
I had learned would only fall to disuse. I only wish I could see him 
now, as I would have better material for argument, as I'm sure if he 
spoke to our local doctors, who by the way are miles distant, he (would 
change his opinion. One must be ready for any emergency, and in serious 
cases such as pneumonia, where the patient can't be taken to hospital 
and the doctor can only come every second day. there is a great responsi- 
bility. 

One of the things that makes District Nursing here a pleasure is the 
co-operation of the doctors. Nothing is loo much (rouble for them, and 
when in doubt over some small illness, where the patient feels they can't 
afford to have the doctor, it' I phone the doctor, he is only too pleased to 
explain the best course to take. 

I find the school-work very interesting and pleasant; the children 
are so enthusiastic, especially the little ones. I find their interest greatly 
stimulated by giving small prizes for health chores, etc. At Christmas- 
time, with the help of the primary teacher, we put on a health play, 
which was very successful. I would like to mention here that the teachers 
are a wonderful help to the nurse, and that it is greatly appreciated. 
The percentage underweight has improved since last September from 
GO per cent, to -IS per cent, at the present lime. I held a tonsil clinic 
early in November for the school-children of Keremeos and Cawston. 
There were eight children operated on, and I have been very pleased to 
see the marked improvement in the children since then. One of them 
gained 4 lb. in a month, and they have not been home from school with 

29 



folds as in previous winters. I started on February 1st to give a series 

of talks and demonstrations in practical nursing to a class of Canadian 

Girls in Training in Cawston, and later I started classes in Keremeos for 

girls from 14 to 20. These classes are well attended and the girls seem 

interested in the work. ,, „ T> x , 

Patricia East, K.X. 



DENTAL SERVICE IX THE ARROW LAKES DISTRICT. 

Concerning denial services among the children of the schools of the 
Arrow Lakes District, undertaken for the Health Department: We have 
been wvy much pleased by the marks of appreciation on the part of the 
children themselves; a pride taken in their clean, healthy teeth and 
months; a willingness to undergo any dental operation required and a 
real sympathetic reception of the advice and admonitions given them. 

But the parents are the responsible ones — responsible for the neglected, 
unhealthy months we often see; and we have been deeply impressed with 
the fact that we have failed to get the %> message of oral health " over to 
that vital source in a personal manner. 

Nine out of every ten pupils came to us unaccompanied by a parent, 
and the opportunities to explain and advise were few and were with the 
aesthetic type, who required it least of all. 

Surely this is where the Public Health Xnrses can help so materially 
in their personal touch with the home environment. They can get these 
important truths over in a sense we cannot, and can explain that the 
time to begin attending to their children's dental needs is not when they 
are in the agonies of toothache, but eight months or so before they are 
born — a matter of intelligent diet and cheerful environment for the pro- 
spective mother. 1,1,0 

Norman K. Carter, D.D.S. 



THE DUNCAN CONSOLIDATED SCHOOL DISTRICT. 

During the past year it has been my privilege to be the Public Health 
Nurse attending the Duncan Consolidated School. The school falls 
naturally into three sections. The 4 ' Big School," as we call it, is a 
modern well-equipped eight-room brick building, tt accommodates Grades 
IV. to VI 1 1., inclusive. A shell' in the cupboard in the library is set 
aside for first-aid supplies. We find that the lysol, iodine, green soap, 
absorbent, gauze, bandages, and adhesive are very frequently in use. 
The school-yard is of gravel and v^vy hard on the knees and elbows that 
come in contact with it. The first-aid supplies are purchased by the 
nurse through the School Board. As this year's appropriation had been 
used 11]) by November, we are going to approach the Sports Club to supply 
the necessary articles, since if is during the try-outs for the sports events 
that most of the casualties occur. 

The Primary School, just across the street from the Pig School, is 
a four-room wooden building, with excellent basement space for a rainy- 

.°,0 



weather playground. The school-yard is of sand and on fine days the 
children revel in it. Rarely may one walk through without encounter- 
ing some moated castle or lonely tower. 

The York Road School is an isolated room of the Duncan School, 
it is situated about a mile from the school proper. It is across the 
railway-track and in the centre of one of the residential districts of the 
town. It is a unit of the Primary School and, placed as it is, has all 
the advantages of a rural school as well as those of a town school without 
their disadvantages. 

Many of the children attending the Duncan School live in districts 
that had until recent years supported one-room rural schools. They 
consolidated with the Duncan School in 1919. The children who live 
a long way from the school are transported by means of school buses. 
Those who live within 2 miles of the school walk in and out each day. 

With regard to medical inspection and health-teaching, the "receivers" 
are examined by the School Medical Officer within a few days of their 
admittance. The rest of the school is weighed and measured and a 
reeord kept. Their normal weights are also charted. The whole school 
is weighed and measured three times yearly, the last time being as near 
as possible to the examination by the School Medical Officer, which is 
usually about May. A report of the medical examination is sent to the 
parents. 

The school as a whole is very interested in health-work. Just recently 
the Parent-Teachers' Association suggested that at their next meeting 
they be entertained by the children. Among the many delightful items 
on the programme was a playlet by the very tiny tots. Eight little girls 
were chosen from the Primary School. Each represented a health rule; 
one child held a huge tube of paste and a toothbrush before her and sang 
a little song telling of her rule; another held a bath-tub; another a 
basket of fruit; and so on, each illustrating her rule with a little song. 

The children now are busily engaged in preparing material for the Good 
Health Competition. The primary grades are doing health-books; the 
intermediate grades, posters; and the senior grades, essays. 

N. Armstrong. 



VICTORIA, li.C. : 
Printed by Charles F. Bani'ield, Printer in the King's Most Excellent Majesty. 

li)27. 



'.<J0-427-7(i04 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 APRIL, 1928. No. 5 



PERHAPS no class of the community has to take into consideration 
the question of view-point as often as a District Health Nurse, a 
school-teacher, or a preacher in the rural districts. Not only must they 
reckon with the view-points of those witli whom they deal, but they must 
have a well-balanced view-point of their own. 

The varying effects of view-point can be illustrated well by experi- 
ences of mountain-climbers who laboriously toil up to the summit of a 
mountain range. Behind them is the valley whence they came, before 
them other landscapes of varying beauty, but all tending to distract 
the mind from what prevailed in the valley below and to put new hope 
into the adventurers. 

The Public Health Nurse often feels discouragement because of sur- 
roundings and the vexations which they produce, but, like the mountain- 
climber, she can climb up from the valley of depression through mental 
effort and from the mountain-tops of self-control see beyond the vexing 
problems of every-day life to the great goal in the distance. 

In the daily work of the public-health work there are many dis- 
couragements, it is true; but on the other side of the picture there are 
many signs that her achievements and her efforts are bearing fruit. 
Compare the mental attitude of the public of to-day with that of ten 
years ago, and surely there is ground for confidence. This change within 
ten years justifies us in viewing our goal fifty years hence, which is an 
Al nation composed of an Al population. 

On the other hand, an interesting book to read, the company of 
congenial friends, or indulgence in a meritorious picture display may be 
used as a means of driving away a feeling of discouragement or 
antagonism. With the mind once more poised the District Nurse can go 
forth to her work with a different view-point from which to deal with 
her daily problems of not only sickness but family disorders among those 
whom she attends. 



FOKEWOKD. 

Training Public Health Nurses is a fascinating business, by no means 
yet brought to the point of classical perfection. Nor will it ever be 
brought to that point until public health itself is a finished product. 
This is equivalent to saying that training Public Health Nurses will 
never be quite perfect) because public health never will be quite perfect. 
Even approximate perfection in public health is many a long day — years 
at least — centuries probably — ahead of us. Public health depends on 
every other science, and all sciences are yet imperfect — even mathematics. 
Public health depends also on human intelligence — we need hardly 
comment on its present state. 

Put the above considerations are just those which make public health 
to-day the most fascinating of all big business — because to-day we have 
the chance to build up, devise, design, direct to some extent at least, the 
development of public health at its most interesting stage. The heaviest, 
hardest, least organized, least co-ordinated work has, much of it, been 
done. The building-stones have, many of them, been more or less well 
hacked out; some of them have been more or less well fitted to each other. 
We may begin to see something of the ultimate thing we are erecting. 

Leaving metaphors, the more we know of public health, the better we 
can train public-health people in general and Public Health Nurses in 
particular. Public-health knowledge is every day increasing. Our 
courses to-day cannot be what they will be ten years from to-day. But 
the Public Health Nurse graduate of to-day will, ten years from now, have 
had not merely what training we can give her now, but ten years of that 
training which the big world has meantime given her — a training obtained 
not under university supervision, but under the nurse's own supervision. 
Our training is but the introduction to the larger and better, if rougher, 
training of the real world outside. Our most earnest desire is to so equip 
our graduates here that they will meet, equably and well, this rougher, 
sterner, more exacting training — will see in all their future work, not 
just a job, but a chance for study, for construction, for the pushing 
forward of public health from what it is to what it some day will be. 

Observe, record, study, think out, all that you encounter, whether 
you are a non-graduate, an undergraduate, or a graduate. This applies 
to real life and to the more or less inaccurate reflections of real life that 
books or teachers give. If all of you do this, we need have no fears for 
the public health of the future. 

Dr. H. W. Hill, 

Professor Public Health Nursing and Bacteriology Director, 

Vancouver (lateral Hospital Laboratories. 



TABLE OF CONTENTS. 

Page. 

Editorial. Bv Dr. II. E. Young.. 1 

Foreword. By Dr. II. W. Hill 2 

Theory axd Practice. By Frances Lyne 5 

Progress ix Health-work ix Armstrong. By P. A. Charlton 5 

Greetings from Sayward. By Edith M. Walls 7 

First Impressions op School Nursing — Duncan. By .Margaret A. 

Thatcher 8 

School Nursing ix Nanaimo. By Margaret E. Kerr.... 9 

Public-health Work ix Port Alberni. By Mary E. Grierson 10 

School-work in Vernon. By Mrs. S. Martin 10 

Esquimalt Rural Nursing Service. By Helen Kelly.. 11 

Saanich Health Centre. By S. Ilewertson 13 

Child-welfare Work in Saanich. By N. Higgs 14 

Cowichan Health Centre — Starting Work at Bamberton. By 

M. Claxton 15 

Public-health Work in Qualicum District. By J. A. Dunbar 1(1 

Dental Clinic in Oliver District. By Norman H. Carter, D.D.S 17 

Public Health in Nanaimo. By A. Verna Becklev 18 

Keremeos District. By Kathleen Snowden 1!) 

School-work ix Fernie. By Winnifred E. Seymour 20 

Teaching Public Health ix Ka.mlooi-s. By Olive M. Garrood lil 

Progress ix Rural Public Health Nursing. By Isabell M. Gibb 23 

Cowichan Health Centre— Notes for the Guidance oe Public 

Health Nurses. Bv Mrs. M. Moss... 25 



r^? 




m 

\ 

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y. 



> 



THEOEY AND PK ACT ICE. 

Not very long ago I was looking forward to that wonderful event — 
graduation. I thought of graduation then as the top of the hill. I think 
of it now as the gateway to a vast and interesting land — practical 
experience. Fresh from graduation, I was full of theories and ideas and 
burning for an opportunity to apply them. Soon the chance came to 
put them to the test, and then it was that the real and practical difficul- 
ties presented themselves — difficulties! which the enthusiasm of the student 
had overlooked. 

The Public Health Nurse is very much a pioneer and an educator. 
By patience, perseverence, and repetition she must overcome prejudice, 
ignorance, and dread of the unknown. So gradually the startling fact 
that the Public Health Nurse is at the mercy of the public came home 
to me. The beautiful theories and the splendid new ideas, 1 realized, 
were useless without co-operation from the world at large. The impor- 
tance of making friends became evident. Making friends is an art and 
one which it is very hard for some to cultivate. Put it is an essential 
in public-health nursing. Just how much can be accomplished by tact 
and friendliness came as a revelation to me. How do a Public Health 
Nurse's patients regard her, 1 wonder. Probably as some one to call on 
in time of sickness, not as some one to instruct them in the prevention of 
sickness. A good deal of diplomacy, therefore, is necessary in the accom- 
plishment of educational work. 

Making friends, being tactful, co-operating with others, and gaining 
their co-operation in return, educating the public how, when, and where 
opportunity presents — these are only a few of the demands made upon 
the Public Health Nurse. Thus the intricacies of the work unfold them- 
selves and as they do so the interest grows. The thousand-and-one things 
which no training-school and no college can teach must be learned in 
the great school of life — by bitter experience, so to speak. But it is not 
all bitter; there is much sweetness mixed with it, and the whole is 
seasoned with many a good laugh. 

Prances Lvxe, 

Saanich Health Centre. 



PEOGEESS IX HEALTH-WOBK IX AEMSTEONG. 

In Armstrong we have tried to improve the health of the pupils, 
keeping in mind that the child's best health is essential to his best 
progress in school as well as lo his best work and fullest enjoyment in 
after-life. 

After two years' school-work one looks for a certain number of results. 
The evidence of progress is healthier children. Although the actual 
figures are more than gratifying, we still feel that we have a long wax 
to go yet. 

Malnutrition was one of our greatest problems. In September, 1025, 
28.8 per cent, of the pupils were more than 7 per cent, underweight and 



2 per cent, were over 20 per cent, under weight. All sorts of schemes 
and competitions were tried to belter thisi grave deled;, but finally we 
have round the serving of milk at 10 a.m. to be the best of all. Straws 
are provided, a fact which seems to make the drinking of milk quite an 
interesting' incident in the day's programme. Children who could not be 
persuaded to drink milk before now drink it, apparently with enjoyment. 

Most of the children bring their own milk, but in some of the needy 
cases it is provided. 

One little girl who drinks her pint at 10 gained more in the last 
seven months than she did the three preceding years. In one Grade 
IV., after one month's trial of milk at 10, the class average in arithmetic 
jumped from 50 to 75 per cent. The average gain per pupil was over 
three times the normal gain. 

At noon a hot drink, soup or cocoa, is given to the underweights. 
For a time drinks were given to all, but as there are over 300 stay to 
lunch, that is quite a problem. 

At lunch-time the pupils are required to take a certain Length of 
time for eating. This has done away with the "'too quick lunch." 
Formerly some of the pupils took less than live minutes for lunch. 

In the health classes great stress has been put on the well-balanced 
meal. The children are taught and encouraged to eat a hot cereal break- 
fast, fruit and vegetables, as well as milk every day. 

About sixty of the pupils have been taking cod-liver oil during the 
winter months. 

At the end of December, 1027, S per cent, of the pupils were more 
than 7 per cent, underweight. 

Probably our best results have been obtained through the dental 
clinic. In the last two years 270 pupils have received dental treatment 
throngh the clinic. The pupils of the senior grades are almost devoid of 
any dental caries. Two years ago 85 to 00 per cent, needed treatment. 
Fully 95 per cent, of all pupils give their teeth daily care. 

Diseased tonsils have been other thorns in our flesh. Whether this 
community is worse than the next for defective throats it is hard to say, 
but it does seem that there are an incredible number of children with 
diseased throats. In the last two years seventy-five have had their lonsils 
removed. 

Last spring we had a, tonsil clinic, treating a number of indigent 
pupils badly in need of treatment. The cost of the clinic was *17o\ which 
we raised by holding several dances. It was a lot of work, but the 
improvement in these boys and girls has well repaid us. One little chap 
was becoming very deaf; now he can hear almost normally. 

in 1926 we had an eye clinic costing about $86. As there is no oculist 
here we had one come over from Kamloops. Besides the twenty-one 
examined at the clinics, thirty others have had glasses fitted. There are 
still about ten in the school who are very much in need of glasses, but 
their parents, although quite able, refuse to stand the expense. They 
seem to think it just a lot of tomfoolery. Educating these people is one 
of our greatest trials. 

6 



There has been a great improvement in the pupils taking the stearo- 
dine tablets. In a great many cases the gland has subsided to the normal 
size. In one large family in the district all the children have enlarged 
thyroids. The two oldest boys were unable to take the treatment, but 
the next three have 'been greatly benefited, so much, indeed, that the 
mother asked for treatment for the little ones at home. 

The pupils have made a wonderful effort to improve their own 
personal cleanliness and the school in general. This is probably due to 
the fact of a banner being given to the room scoring the greatest number 
of marks each month. The rooms are marked for the floors, desks, 
radiators, blackboards, lobbies, pictures, plants, and pupils. It has made 
a wonderful difference in the school. All of the rooms are very attractive. 
The clean light walls are hung with pictures and athletic trophies. What 
a contrast to the drab grey walls decorated with spit-balls of my day: 

The hearty co-operation of the principal and his staff and the material 
aid from the different organizations in the district have been a great help 
in our health programme. 

Look where the dawn is kindling in the East, 
Brave with the glory of the better days. 
A countless host, an endless host, all fresh 
With unstained banners and unsullied shield. 
And great young hearts that know not how to fear. 
The children come to save the weary world. 

P. A. Charlton. 



GREETINGS PKOM SAYWARD. 

Another year has passed since our last Refresher Course, where we 
all met to talk over our little difficulties and troubles. 11)27 has been an 
anxious one for some of the residents in the valley. There have been 
accidents and sickness, some of which I have been able to help; others 
I have not. 

The majority of the school-children have been free from any actual 
sickness, with the exception of one who had a very serious operation and 
has not yet recovered. Two of the children suffering from enlarged tonsils 
have been operated on, a vast improvement being the result. 

We were also fortunate in getting the dental services of Dr. Yonlden, 
of Victoria, to attend to pre-school and school-children's teeth, which 
service was very much appreciated by the parents. 

At the smnmer closing exercises at the Upper School a little health 
playlet entitled " The House that Health Built " was acted by six pupils, 
each bearing a different poster which illustrated the different articles of 
food which should be eaten every day. 

At the Christmas concert both schools united and gave a very good 
selection of songs, recitations, and dialogues, which were much enjoyed 
by the audience. 

With best wishes for success to my fellow-workers, 

Edith M. Walls. 

7 






FIRST IMPRESSIONS OF SCHOOL NURSING— DUNCAN. 

In the few months' experience that I have had of school nursing it 
has been borne in upon me very strongly That the success and value of 
the work depends very largely upon two factors: First, the realization 
of the importance of the work on the part of the teachers and their willing 
co-operation; and, secondly, a full understanding on the part of the 
parents of what it all means and what we are trying to do. 

Where the nurse is doing generalized work over a large district, it 
is of course impossible for her to visit every class in every school daily. 
And yet some sort of daily supervision seems to be necessary if health 
habits are to be really formed and minor infections kept in check. Here 
the teacher can help tremendously, not only by keeping the nurse posted 
up to date with names of absentees — so that the cause can be promptly 
investigated — but also, by a quick daily inspection, she can do a great 
deal to encourage cleanliness, and can then take special note of any child 
that needs to be referred to the nurse. In the primary classes especially, 
the teacher can do much towards stimulating the interest of the children 
in "health." Some teachers are extremely helpful in these ways, and 
the result can be noted in their classes. Others do not seem greatly 
interested. Perhaps they do not consider it a part of their work. 
I wonder how far one is justified in thinking that it should be. 

And it is not only in these concrete ways thai the nurse needs the 
help of the teacher. Their mental altitude towards the work is bound 
to react on their classes. If the teachers think it is important, the 
children are more likely to do so; but if, on the other hand, they regard 
the coining of the nurse for the monthly inspection and health talk as 
a somewhat irrelevant interruption that has to be put up with as grace- 
fully as possible, what value are the children likely to attach to it? 

It seems as if, though personally always friendly, some of the teachers 
are not quite alive to the possibilities of the nursing service, nor to the 
close relation between physical health and progress in school. But 1 
understand that more emphasis is being laid on this point in normal 
schools nowadays. 

As for the parents, their help is essential. Fortunately a great many 
do seem to understand that we really are interested in their children, 
and are grateful for the help that they know we are qualified to give them. 
Others — either through blissful ignorance or because they are so busy — 
are hard to rouse to a sense of their children's needs, but the most difficult 
mother to deal with is the one who is so complacently sure that all she 
does is right, and that there is no room for improvement either in herself 
or in her family, in spite of much evidence to the contrary. 

When parents, teachers, and nurses all wake up to the fact that, 
after all, we are all working towards a common goal — namely, the 
welfare of the child in all its aspects — and will agree to all work together, 
what wonders will be accomplished. In the meantime, I suppose, educa- 
tion is the watchword, and, at any rate, by teaching the children in the 
schools much may be done for the coming generations. 

Margaret A. Thatcher. 



8 



SCHOOL NURSING IX NANAIMO. 

The past year has been very encouraging from every point Of view. 
Parents are more keen on remedying the defects of their children; teach- 
ers, more interested in the teaching of health as a regular subject on the 
curriculum ; and the pupils, more ambitious to follow the health teachings 
we are all expounding to them on every possible occasion. 

Realizing the value of proper nourishment to the school-child, the 
Bastion Chapter of the I.O.P.E. has taken up the work of supplying milk 
to the puj)ils during the morning recess period. The population of 
Nanaimo is composed very largely of working-clans people. There is a 
tendency to exaggerate the value of such luxuries as automobiles, moving 
pictures, etc., among the people. The result is that comparatively few 
children have anything like the proper amount of milk daily. Our scheme 
is only in its infancy so far, but it is receiving the cordial co-operation of 
parents, pupils, and teachers. About -•"> per cent, of the pupils' are taking 
advantage of the service. It is too soon yet to make any predictions as 
to the bearing this will have on the health of the pupils, but we are 
expecting real results. 

The Parent-Teachers' Association has undertaken to support a school 
dental clinic. While we have not made much progress yet, we are hoping 
for better things. All the energies of every organization in the city have 
been turned to the raising of Funds to complete the new hospital. This 
has meant the claims of the denial clinic have had to be held in abeyance. 
Its value, however, is fully realized and already ;i fund haw been estab- 
lished. We hope the clinic will be properly organized by next year. 

This year I have been co-operating with the teacher of home economics 
and have given the series of classes to the "Little Mothers" as part of 
the routine Grade VIII. work. This has proved a much more satisfactory 
arrangement than holding the clasps after school. The last half-hour 
of each domestic-science period has been so used. There will be a large 
class receiving diplomas this time. 

For the past four years a system of treatments for common goitres 
has been carried on in the schools under the direction of the School 
Medical Health Officer, Dr. Drysdale. Careful measurements have been 
made periodically and results thai are both astonishing and gratifying 
have been obtained. Only a very few have not shown improvement. 

The Manual Training Department has erected boards for us in the 
schools. We are using these to display the large health posters supplied 
by the Provincial Board of Health. It is very interesting to note the 
reaction of the pupils to each new display. 

We have also had a show-case put up in the office in which practical 
exhibits are made. The first one showed the article used in performing 
the morning toilet. Others of equal interest are planned. 

School nursing has its amusing side too. The following are a few 
of the "howlers" obtained from exam, papers: — 

Pasteurized milk is milk that has been very carefully detached from 
' infectious germs. 

Pasteurized milk is canned cream. 



We have two sets of teeth, temporary and perennial. 
We breathe in oxygen in the daytime and breathe out carbon dioxide 
at night. 

Before food can be carried by the blood it must be turned into enamel. 
The water that comes on our faces when we ran is called inspiration. 

Margaret E. Kerr, E.N. 






PUBLIC HEALTH WORK IX PORT ALBERNI. 

Two months ago public-health work was organized in Port Alberni 
and district. A generalized programme is being established, possibly a 
unique feature being a form of industrial nursing done for two large 
lumber companies, nursing visits) being free to all their employees, the 
companies paying a substantial sum monthly towards the expenses of 
the work. 

A home-nursing class is well attended at Great Central Lake, which 
is 14 miles from " The Port," where one lumber-mill is situated. Another 
class is being formed in town. 

There are five country schools, as well as the town grade school, all 
of which are visited every two weeks at least. A great deal of interest is 
being taken in the health crusade by some of the grades. Sample tubes 
of tooth-paste to those having clean hands and teeth in the lower grades 
have aided in interesting some of the children in cleanliness. The ready 
co-operation of the teachers is of great assistance in that work. 

Prenatal and infant-welfare work is being met with sympathetic 
response. Advice is asked for by phone, as well as in the homes. 

The executive of the Bed Cross Society, who are the committee here, 
are keenly interested in all phases of the health programme, and are 
working hard to establish a baby clinic in the near future. 

I hope that when the next Bulletin is edited ,% The Island Western 
Coast Health Centre'' will be able to give a report of work done. 

Mary E. Griersox, B.N. 



SCHOOL-WORK IN VEBNON. 

The Vernon Consolidated School District is quite large, making it 
necessary to use three large trucks to convey children living in the out- 
lying districts to and from school. We have approximately 1,000 children 
in the different schools. There are five school buildings, one of which is 
used entirely for manual-training classes!. The School Nurse's office is 
in the largest building and all the other schools can be reached by tele- 
phone or by a short walk. 

My work during school-hours is confined entirely to work in the 
schools, the time being spent in visiting the class-rooms, twenty-five in 
number, getting the names of absentees, which is done once a week; 
inspection of classes, each class being inspected once a month, attending 
to minor ailments and teaching health to all grades. Each class receives 

10 






one-half hour instruction weekly, the girls of the first-year high school 
having a longer period and instruction on hygiene and home-nursing. 

Having lived in Vernon for some years, I am fairly well acquainted 
with the people and am able to inquire by telephone regarding sick 
absentees. All actual home and follow-up visits are made after school, 
unless it is an urgent case; any extra time is spent making social service 
and child-welfare visits. There are four excellent medical men in Vernon 
and an exceptionally up-to-date general hospital, which is also a training- 
school. I am in close touch with the medical men and the hospital staff, 
especially during a threatened epidemic. 

In blocking out the year's outline for the health-teaching in the 
different classes, I use the "Course of Study" as a guide, enlarging on 
certain subjects each month so that as much as possible can be covered 
in the school-year. The teacher is always present during these talks and 
takes up that particular subject with his or her class some time later 
on in the week. Health posters are made on all the important subjects, 
and practically all the teachers have such posters on their class-room 
walls. Certain rules are given with each lesson and project-work is also 
done "by way of health-books. In the junior rooms health-teaching is 
accomplished mostly in story form. 

During February of this year we had a Safety-first Week, and a 
competition was held in every class-room for the most original health 
poster. 

May Day — a part of the regular May Day school parade is the health 
parade, and in 1!)2(> we were fortunate enough to receive first prize for 
our Red Cross car; the illustration does not show the health banner 
at the back of the car, and only a part of the health brigade, which was 
made up of boys on decorated bicycles. 

A great improvement has been made in the Vernon schools since the 
event of the School Health Nurse, my predecessors having done the hard 
pioneer-work; still there is a great deal to be done. ''Rome was not 
built in a. day," and we are hoping for better results each year. 

(Mrs.) S. Martin. 



ESQUIMALT RUKAL NURSING SERVICE. 

As one looks back a few years to the time when public health was 
first put into practice in the Province in the form of Public Health 
Nursing Centres or Services, one cannot but be impressed with the almost 
phenomena] growth and development that has taken place. 

To quote Dr. Young, Provincial Health Officer's own words in his 
opening remarks in the 1!)2(5 Bulletin, " Progress and improvement are 
proven by the evidence of actual accomplishments." Years of hard work 
put in by the Public Health Nurses in the field, the man at the head, 
Dr. Young, and the organizers of Public Health Services are beginning 
to bear fruit. This is evidenced by the fact that the public are now eager 

11 



for knowledge in respect of health matters, and a much greater enthusiasm 
is shown among - the people in tin's community and those other communities 
fortunate enough to have a Public Health Service organized. 

Also, the enthusiasm is spreading. Neighbouring communities are 
seeing the value of a Public Health Service, and our own association is 
in receipt of communications from neighbouring districts asking for infor- 
mation regarding the process of organization. 

During the past year 1 have conducted a course of twelve lessons 
in home-nursing for the Sooke and Otter Point Women's Institutes, 
jointly, and the ladies who attended the classes took keen interest in 
them, preparing excellent papers for the final class. Good work can he 
done along these lines. 

It is almost impossible to enumerate the many phases that come 
under the heading of public health. The problems are many and varied. 
In our own association during the past year Ave have taken up the question 
of sanitation of much-frequented public beaches; dangerous corners in 
the roads in the locality; and the question of grants in respect of dental 
work in the schools; in the hope that our endeavours will lead to 
improvements in the near future. 

In addition to our dental work among the school-children, which we 
carry on continuously, children requiring treatment being taken in to 
Victoria to the dentist on any Saturday morning (we continue to hold 
two full examinations of all children attending school during the year), 
we are extending our clinic-work this year to include monthly pie-school 
clinics, where mothers may bring their children to he examined by a 
physician and receive advice regarding the correction of any physical 
defects and bad habits. 

Last year, on May Day, we celebrated our first annual Child Health 
Day in the form of a health pageant. The Women's Institutes co-operated 
and some excellent floats were entered by the different institutes and 
Boards of School Trustees and the pageant opened with a health parade. 
Floats representing fresh air, out-of-doors, the foundations of health, the 
Queen of Health, etc., and gaily decorated cars, fell into line; and practi- 
cally every one in the district turned out to witness this first annual Child 
Health Day. The .Maypole dance and other pretty folk-dances, health 
plays and exercises, sports, etc., were all enjoyed during the afternoon, 
and the only refreshments served were bottles of milk, which had pre- 
viously been arranged in a milk display, and ice-cream and biscuits. In 
the evening addresses were given at a crowded meeting by Drs. H. E. 
Young, Irene Bastow Hudson, and David Donald, and some splendid 
health films were shown. Prizes were given by the association and other 
interested people for the best health posters done by the school-children, 
which were all on display in the hall, and a silver cup was presented by 
R. I. Van der Byl, an ex-president of the association, as a challenge 
trophy for the annual sports. Another cnp has been promised for this 
year. We would like to see May Day celebrated all over the Province 
as Child Health Day, and the day given np to a review of the health-work 
done during the year among the children. 

12 



This year we shall again celebrate May Day, but in some different 
form to keep up the interest. The committee is trying to think up some 
scheme whereby it can raise some money wherewith to provide some 
simple equipment to encourage health-giving playtime sports and exercises 
in the schools or school-grounds. 

As each year I am called upon to submit an article for the Bulletin, 
so each year I find an increasing difficulty in preparing an article for 
publication; not because there is less to report or write about, but 
because there is so much, and only a limited amount of space for each 
article. To record all that we have done, all that we have tried to do, 
and all that we hope to do would require the whole of the Bulletin for 
ourselves, which would not answer the purpose of the publication. We 
all like to read what the other public-health workers are doing and to 
learn something from them. I will therefore content myself with conclud- 
ing my effort this year with a summary of what, from my long experience, 
I consider are a few of the very necessary and important factors in the 
successful organization of a Public Health Service. 

First of all, service must be the keynote. Service in all things — not 
merely in nursing. A nurse in the public-health field must be prepared 
to co-operate in all things; she must be prepared to respond to any call 
upon her time; to enter into the social life of the community; to accept 
criticism with the same grace as she would accept praise; be professional 
and ethical; make herself the parents' and children's confidante, and 
teach the doctrine of health at all times. A large order, you say? True! 
but not impossible. Then the committee of management must be com- 
posed of men and women who are prepared to give up a good deal of 
their time and talents; who have a broad outlook on life and things in 
general ; business-like men and women, who are keenly interested in 
the work; who want progress and strive for it. Another important 
factor is to obtain the co-operation of the Women's institutes of the 
district, the Boards of School Trustees, and the teachers. In conclusion, 
I am glad to say that the Women's Institutes in my district co-operate 
to the full, as also do the Boards of School Trustees! and the teachers; 
also we are fortunate in having the co-operation of the Farmers' Institute. 
I have a splendid committee to work with and have no fears for the future 
of the Esquimalt Rural Nursing Service. 

Helen Kellv, E.N. 



SAANICH HEALTH CENTRE. 

The Saanich Health Centre has seen numerous changes this last 
twelve months. In August Dr. Berman, D.P.H., was appointed as full- 
time Medical Officer of Health for Saanich, supervising all public-health 
work for the municipality from the Health Centre. This is not only an 
advantage to the public, but also to the nurses who are doing public- 
health work. 

Mrs. Lucas, Nurse Superintendent, who, after her five years' strenuous 
work at Saanich, resigned in October to take up public-health nursing in 
the University. 

13 



Through the School Nurse residing at the Health Centre, the gener- 
alized public-health nursing programme, which was disrupted two years 
ago, has now been resumed. This spares much overlapping of work and 
unnecessary waste of time. 

The enclosed photograph was taken in one of the Saanich schools 
of Dr. Berman, D.P.H., immunizing children of all ages against diphtheria 
with toxoid. 

S. Hewertsox, R.N., 
Nurse in Charge, Saanich Health ('nitre. 




IMMUNIZATION FOR DIPHTHERIA, SAANICH HEALTH CENTRE. 

CHILD-WELFARE WORK IN SAANICH. 

The aim of all public-health nursing is education. One does not see 
the result of educational work at once. In many branches of the work 
one has to wait for several months or perhaps years before definite 
progress is evident. It is difficult to arouse or to maintain a keen interest 
in work that does not give apparent results. 

Child-welfare and infant-welfare is a mos>t absorbing branch of public- 
health nursing. Following the prenatal work it is the most important. 
Conservation of infant-life is not sufficient. Promotion of health by 
correct routine and feeding minimize the percentage of defects discovered, 
frequently too late, during the school-life or later life of the individual. 
The results of infant-welfare work are apparent from the first visit. 

A list of the births in the district may be obtained monthly from the 
District Registrar. Before the infant is a month old the first visit is 
made. The entrance into a home is comparatively simple, when one 
wishes" to see the " new baby." After the first visit the visits should be 
a, monthly occurrence. It is rarely possible to visit at intervals of a 
month to the day. How frequently, if six weeks have elapsed since the 



14 



last visit, we hear, " Why, nurse, I thought you were not going to come 
any move. It is so long since von were here." After the first year the 
visits are of necessity less frequent. The infant develops less rapidly and 
the diet is more constant. 

, The ideal is to have these infants report monthly at the infant clinics. 
The clinics are held at set times in central parts of the district. The 
infants are weighed and measured and any advice on routine or feeding 
may be obtained. 

Perhaps the greatest aid to the Public Health Nurse on infant- welfare 
work is the literature. The feeding-cards supplied by the Provincial 
Health Department are most useful. The mothers welcome all reading 
material relating to the care of their baby. Very attractive pamphlets 
on the care of the child are supplied also by the Metropolitan insurance 
Company. 

N. Higgs, R.N. 



COWICHAN HEALTH CENTRE— STARTING WORK AT 

BAMBERTON. 

That the public is waking up to the advantages of health supervision 
for children, not only during their school-life, but also in early childhood 
and infancy, was demonstrated recently to us by Bamberton, the home 
of the B.C. Cement Company, Limited. 

Bamberton is a compaet little community of cement-workers attached 
to the factory, which can be seen close to the water's edge as one crosses 
on the ferrv from Mill Bay to Brentwood. Things are evidently run on 
progressive lines there. All sorts of devices for prevention of fire and 
accidents can be seen about, and " safety-first " posters and notices. They 
have a very good community hall in the village and there is a pleasant 
atmosphere of good-will and friendliness about the whole place. 

A short time ago we received a letter from the Secretary of the School 
Board asking us if we could undertake a regular monthly inspection of 
their school-children at a certain rate per head per annum. But the 
significant part of the letter lay in the fact that they were most anxious 
that all the children in the village should be included in this scheme. 
The,)' realized the importance of health supervision from babyhood. 

Shortly afterwards I went down to talk things over with the Secre- 
tary, and drawing near to Bamberton I was struck by the thick coating 
of white dust that covers everything. They say that plants and gardens 
thrive wonderfully there, in spite of the dust, but we are wondering 
what effect it has on the children. 

I found the Secretary keenly interested in hearing all about the 
Public Health Nursing Service, and he felt that greater co-operation 
would be secured if the parents could also hear of the work at first hand. 
So it was arranged that Dr. Stanier and myself should go down one 
evening and meet the people and tell them all they wanted to know. 
When the evening came the community turned out in full force — fathers 
and mothers, and consequently children too. 

15 



Besides the " talks," a musical programme had been arranged, and 
afterwards while refreshments were being served we had the opportunity 
of meeting the parents individually. They were most interested and 
anxious that the work should be started at once. So two days later we 
gave the school-children their first monthly inspection, and followed it 
up with visits in the homes, where we found the mothers most responsive. 
Next week the doctor will examine the school-children in the morning 
and hold a preschool child clinic in the afternoon. We feel very grateful 
to the Secretary of the School Board, who by his keenness and helpfulness 
in every way has done so much to put the work on a satisfactory footing. 
We are also lucky in having a school-teacher who realizes the close con- 
nection between the health of the children and their progress in school. 
All nurses engaged in public-health work will realize what a. splendid 
opportunity such co-operation affords, and we hope that we shall be able 
to make the most of it and demonstrate to the public that such service 

is of real value. ^ r _. 

M. Claxtox, 

Duncan. 



PUBLIC-HEALTH WORK IX QUALICUM DISTRICT. 

Generalized public-health nursing in a rural district is vastly different 
from public-health nursing in the city or town, where everything is modern 
and convenient. This is my first experience in an entirely rural district 
and it has taken me some time to get accustomed to my new environment. 
Having been in the district since September last, I have experienced only 
the worst months of the year, which were bad as the winter has been an 
exceptionally hard one. As I look back on the daily troubles encountered 
on snow-blocked roads in an old Ford roadster, never knowing the minute 
the car would be sent skidding into the ditch or over tree-roots into the 
bush, I heave a sigh of relief when I realize that the winter is over and 
there is the bright spring and summer months to look forward to. 

In rural public-health nursing the nurse's duties are very varied; 
there is the educational side in the schools, in the homes with the pre- 
school and infant-welfare visits, as well as the bedside-nursing in the 
home in the bush ; there the change is startling to a nurse who has always 
been used to city conveniences, her resources sometimes being faxed to 
the utmost to cope with the various conditions. I am often amazed to 
see how wonderfully well things are utilized to meet the necessary require- 
ments in these places and the amount of labour it necessitates. Children 
think nothing of walking miles to the nearest store, and water has some- 
times to be carried long distances; even then one wonders if it is fit 
for use, always having to boil it before use. 

Work among the children is very interesting and encouraging, especi- 
ally as I find the teachers assist greatly in their co-operation with the 
nurse, especially so perhaps in the junior grades, where the interest shown 
by the children is excellent. 

The older girls had a Little Mothers' League last year, and this year 
we are taking up home-nursing, covering roughly the principal bones of 

10 



the body, digestion, circulation, and now we have reached home-nursing 
care, the making' of poultices, etc. The classes are held every Thursday 
at 3.45 p.m. in the school in the most central district, pupils coming from 
the other districts. As some of the girls have quite a distance to walk 
I always try and pick some of them up with the car, but on more than 
one occasion they have walked all the way. I try also to take them 
home, though it necessitates several trips; this is not so irksome now as 
I have the pleasure of a new Ford coupe, fate having been kind in allow- 
ing the old one, which has long ago seen its best days, to be burnt along 
with a number of other cars in the garage. 

Our greatest difficulty is in getting the children's defects corrected, 
especially tonsils and teeth, as we are at least 30 miles from the nearest 
hospital or dentist. It is increasingly evident, even in rural districts, 
the marked interest shown in matters of health, and one has countless 
opportunities in the everyday contact with individuals to give helpful 
information, and often have the satisfaction of seeing it carried out. 

J. A. Dunbar, 



DENTAL CLINIC IX OLIVER DISTRICT. 

During autumn of 11)27, at the invitation of Dr. O. II. Kearney, 
resident physician at Oliver, I visited (he district professionally. Find- 
ing that he had solicited this primarily with the school-children in mind, 
we got in touch with Dr. II. E. Young, the Provincial Health Officer, and 
asked if a regular school clinic could he arranged. 

Experience shows that it takes much time and correspondence to 
prepare such a clinic. So, Dr. Young advised an immediate examination 
of the school-children; that the regular notification cards be sent to 
parents where required; that the teachers be urged to co-operate; and 
that, where the sole reason children could not have necessary work done 
was due to financial circumstances, his Department would aid. 

The examinations were very happy visitations indeed. Dr. Kearney 
is a great favourite with the children, lie knew each child personally, 
and as he did all the filling-in of the parents' cards, his presence acted 
as a very confidence-inspiring introduction. 

Five schools were attended. We had dentrifice literature and samples 
to distribute. Some of the former, very attractive, in the form of fairy 
stories, primers, etc., teaching the message of clean teeth in a very inter- 
esting way to the little folks. 

As each individual was examined we had, watching us, a group of 
two or more classmates. We showed appropriate elation over and 
appreciation of the clean healthy mouth, and sympathetic regret where 
a neglected or diseased condition was manifest. The children were very 
responsive, and we got over this lesson of oral cleanliness in a very 
effective manner. 

The children were found to be in better than ordinary condition; 
of the 122 examined, GO per cent, required services however, most of the 
work being in the neglected mouths of about 5 per cent, of them. 

17 



Many parents and all the teachers were enthusiastically assistant, 
and as fast as the parents' cards were signed to show that we had their 
assent, appointments were made for the children and their dental deficien- 
cies cared for. They were invariably appreciative and considerate and 
nearly all a pleasure to work for. 

Fifty-eight pupils were attended; five others reported having been 
to their own dentists; and nine others their intention of doing likewise, 
later. 

And, best record of all, in nearly all cases the parents paid promptly 
the whole sum marked on the card as the cost of the work; in fact, only 
nine individuals asked to take advantage of the Department's aid. 

So the children of Oliver District arc in the enviable condition of 
having the entrance to their bodies in a state of health nearly 00 per cent, 
reasonably perfect. 

Thanks, then, to the Provincial Department of Health that made 
this possible, and to the physician, and citizens of Oliver District who 
responded so thoroughly to the opportunity. 

Norman R. Carter, D.D.S. 



& 



PUBLIC HEALTH IX NANAIMO. 

It is only three months since being assigned to Nanaimo, so probably 
my perspective of the district is a little warped. But from observation 
and actual experience in this brief time, the Public Health Nursing- 
Service appears to be specializing in obstetrical work, a one-sided pro- 
gramme indeed. Doubtless we are receiving many of the cases due to 
the hospital here being closed. With the nearesl hospital 20 miles distant 
and filled to capacity at all times, our doctors are working at a great 
disadvantage, and were it not for the superhuman efforts put forth by 
some of the leading physicians the mortality of the prospective mothers 
would be deplorable. As it is, the life of the infant is the price paid in 
many instances, and this, I feel sure, would be lessened were the hospital 
in operation. 

Our well-baby clinic flourishes. Every week sees new babies initiated 
into the game of health, and when a mother brings in her second baby, 
only IS days old, to be enrolled in the same clinic that helped her with 
her first baby, we feel that our first labours were not in vain. And s<o 
progress is being recorded in one phase, if not another, of our health 
programme. 

At no time has it been necessary to make a diligent search for cases, 
physicians, insurance agents, and other welfare agents' all showing the 
spirit of real service in their co-operation. Work is plentiful, so plentiful 
it is bewildering at times. 

Primarily, it is the needs of the people that must be met, and only 
in carrying out a well-balanced programme can this be made possible. 
To enable us to attain our goal may we be granted an increase in staff, 
and that right early ! 

A. Vkrxa Beckley, P.H.N. 
IS 



KEREMEOS DISTRICT. 

Keremeos is a little town which is hardly on the map as yet, but it 
provides plenty of interesting experiences for its Public Health Nurse. 
The district which the nurse covers is by no means large in area. It 
consists of the two school districts of Keremeos and Cawston and is about 
15 miles in length and 5 miles wide. Just a rather small but fertile 
valley along the Similkameen River. To the east there is nothing except 
a few ranches and an Indian reserve. West, more Indians and about 
20 miles up the river a fair-sized mine. North Ola 11a. which was once 
one of those mad little mining towns one reads about, but is now a tumble- 
down collection of huts occupied by half-breeds. This, fortunately for 
the nurse, is not in her district, but still she is expected to answer 
emergency calls here and also from any of the ranches within reasonable 
distance. 

A train comes in and out three times a week, usually half a coach 
and two trucks, and a stage runs in from Penticton on alternate days. 
There are only about 500 inhabitants in the valley, and financially things 
are in a bad way, as is the case in most fruit districts at the present time. 
In spite of this, however, the people are very keen where the children 
are concerned, anxious to co-operate as far as possible, and in spite of 
the xcvy large percentage of defects the children, taken as a whole, 
represent the cleanest and healthiest little flock it has been my privilege 
to work amongst. There has not been one case of communicable disease 
within the last nine months, with the exception of our ever-present friend, 
the common cold. 

The nurse is tin-own very much on her own resources. Princeton 
is 45 miles away, but connected by rail or road. Penticton is ?>0 miles 
by road, but at times the roads are almost impassable. During the last 
winter there were a few days when the store-shelves were looking very 
sorry. It was during this time that the town's pet bootlegger became 
seriously ill. A slide had blocked the railway and the roads were 
impassable. However, the phone was still working and the doctors were 
kindness itself in giving advice. AVe pulled him through and the town 
gave a mighty sigh of relief. 

Later I was not so fortunate, had to keep a, serious case over from 
Sunday afternoon until Monday morning. He died just before the train 
reached Princeton as the result of strangulated hernia. I knew when 
I was called that his only hope lay in immediate operation, but it w r as 
impossible for the doctors to get in or for me to get him out. • 

Recently the liquor store opened and we had action almost immedi- 
ately. I was quite alone in my little cottage one night when T was 
awakened about 2 a.m. by a loud knocking and a happy but slightly 
inebriate voice talking to my cat. T slipped on my dressing-gown and 
opened the door and two very tough-looking individuals came pushing in. 
They seemed slightly offended at my hesitation in producing a light and 
proceeded to tell a very long tale about a quarrel. I left them talking 
and went on I to look in (he car, and found a young breed very badly 
stabbed and almost pulseless from haemorrhage. The young dentist is 

19 



my right-hand man in trouble, so T ran down the street and threw pebbles 
at his window. He came and gave me help and courage. Fetched the 
telephone-girl to connect the phone, notified the police, and telephoned 
Penticton for a doctor. The doctor, arriving at 7 a.m., found that one 
thrust had penetrated the lung, only missing the heart by an inch. They 
sutured and made him safe to move, and I turned my car into an ambu- 
lance and took him to hospital — a three-hour drive. 

Since that time 1 I have again had to turn my car into an ambulance, 
arriving home on Monday morning at 5.50 a.m. These trips usually mean 
having to dig out of at least one snow-bank. It is never safe to journey 
without a. shovel. My car ami 1 have braved some very treacherous 
roads, sometimes seeming almost reckless in the attempt, but we are so 
far from medical aid and the doctors find the trip so difficult that, when 
it is at all possible, serious cases must he sent to hospital either by train 
to Princeton or in my car to Penticton. 

A word about the car. It is a Tudor Ford. The front seat folds 
down and with an apple-box, plenty of cushions, and a cot mattress a most 
comfortable bed, on which even an adult may lie at full length, can be 
made. This is a wonderful advantage and makes the journey more com- 
fortable and safer for the patient. 

Kathleen Snowdox, K.N. 



SCHOOL- WOEK IX FERNIE. 

I have been but a very short time in Fernie as School Nurse, having 
come here at the commencement of the present term. Since taking up 
my work I must say that I have had the 1 most wonderful help and co-opera- 
tion from the principal and staff. I am not taking all the credit to 
myself, but imagine that if came about largely owing to the fact that 
1 happened to arrive just at the psychological moment. 

There had been no nurse here since the previous June, and when I 
came the district was in the throes of a scarlet-fever epidemic, so there 
was plenty of work to be done. The epidemic, I am glad to say, is very 
mild and is now well under control, but it gave me a wonderful oppor- 
tunity for making the " home contact." 

There are a great many foreigners in this district and many of the 
children suiter from malnourishment, but I find them much more teach- 
able than a majority of the white people. 

In the matter of nutrition-teaching I am very fortunate 1 in having the 
co-operation of the domestic-science mistress, and we are hoping to put 
on a joint demonstration in either March or April. 

I have a comfortable and well-equipped office in the central school 
and the School Hoard does not refuse any request for further supplies. 

1 feed that there are infinite possibilities for the work here in Fernie 
and am proud of having been given the opportunity to bed]). 

Winnifred E. Seymour, K.N. 
20 



TEACHING PUBLIC HEALTH IX KAMLOOPS. 

Health, wealth, and happiness — what happy, wholesome thoughts 
these three words convey to the mind! We all want these things. We 
can all have them. Why, then, do we not possess what God has meant 
us to have? 

The reason is this: Because we do not obey the laws of nature, which 
are God's laws. These gifts are our own birthright and inheritance. Yet 
how many of us possess these gifts? The more one does school-work, 
the more one realizes Hie great necessity of educating the parents as well 
as the children along the lines of natural laws of health. 

It was certainly surprising to find in October last that out of 848 
children attending school 30.4 per cent, were 5 lb. or more underweight 
for their age and height. This percentage ban now been greatly reduced. 
When examining teeth and tonsils a large percentage of children were 
found with soft crumbling teeth, malformation of the jaws, and enlarged 
decayed tonsils. Parents ask me why should they pay such large dental 
bills. This question, as well as a great many others that parents ask me, 
can be answered in two words — unbalanced diet, which has usually existed 
from birth. 

The importance of breast-feeding the baby for the first nine months 
cannot be overestimated. Why will not mothers learn more from our 
animals of the fields? In many cases these animals act superior in their 
wisdom to ourselves in our so-called civilization and progress. The sooner 
that mothers, who are the architects of humanity, realize their grave 
responsibilities to our future generations, the sooner we shall be able 
to build a healthier, happier nation. 

It is amazing to see the number of babies' that are not breast-fed as 
nature intended them to be. They are weaned at the slighest excuse and 
put on cow's milk and water, which mixture is not even balanced to the 
right percentages to correspond with mother's milk. It is in these 
mixtures that we find such very high percentages of protein, in many 
cases up to from 2 to 3.5 per cent. 1 am sure that had nature intended 
human babies to have that percentage of protein it would have been 
provided in mother's milk. Note the following tested comparisons: — 

Sugar. 

Mother's milk 7.0 

Cow's milk 5.0 

Balanced humanized milk.. (5.!) 

Unbalanced cow's milk with 

water and sugar added 8.6 

It is Sir Truby King, of New Zealand, who has reduced the infant 
mortality in that country to be the lowest in the world. I am often asked 
how he achieved this. He did it by proving that breast-feeding isi the 
really natural method of feeding for a baby, and this point is the funda- 
mental principle of his success, lie has devoted twenty years of his life 
to this one great study for humanity's sake. His motto is, " It is wiser 
to erect a fence at the top of a precipice than to maintain an ambulance 
below." 

21 



Fat. 


Protein. 


3.5 


1.5 


3.5 


3.5 


3.5 


1.5 


2.0 


2.5 



The mothers are taught how to re-establish the milk-supply. This is 
done by the simple method of bathing the breasts with hot and cold water 
alternately, massaging daily, and stripping them after each feed, and 
regular three hourly to four hourly feedings; no feed between 10 p.m. 
and 6 a.m. Then the babies are weaned at 9 months and are given 
humanized milk until they are 12 to 13 months of age. The mixtures 
for this humanized milk have been worked out scientifically to be exactly 
the same as mother's milk. That is why it is called " humanized milk." 
The protein, of course, is increased according to the babies' ages; cereals 
and fruit-juices are also added to the diet. 

Yet in spite of the research-work done by Sir Truby King, and the 
scientific mixtures prepared by him, one so often finds babies fed on 
mixtures which are absolutely unbalanced, such as: — 

Sugar. Fat. Protein. 

Unbalanced diet 8.6 2.0 2.5 

Humanized milk 0.!) 3.5 1.5 

Unman milk 7.0 3.5 1.5 

Many babies are even given whole cow's; milk at the age of !) months. 
Following are the latest statistics, which are well worth reading care- 
fully :— 

Deaths from infant diarrhoea (under 2 years) per 1,000 births — 

Per Cent. 

New Zealand 2.25 

Dunedin (home of Phmkett system) 0.8 

No deaths in last two years. 

Australia 18.0 

Great Britain 15.0 

Canada 24.0 

Vancouver 3.5 

United States 15.0 

New Zealand, 1007 0.0 

New Zealand, 1020 2.5 

Infant mortality (under 1 year) per 1,000 live births — 

New Zealand 30.8 

Canada 78.0 

British Columbia 58.4 

Vancouver (1025) 44.0 

United States 77.0 

Great Britain 75.0 

Australia 57.0 

New Zealand, 1007 88.8 

New Zealand, 1020 30.8 

One can only realize that the principle underlying these figures is 
that of wrong feeding. Tt seems to me that this high rate of infant 
mortality cannot be reduced until natural methods of feeding are both 
advocated and established world-wide. 

22 



Great success has always boon found in humanized milk when a baby 
has been weaned at an early age. It is not only in the infant and the 
pre-school child that we see the result of wrong- feeding. I can only make 
the same deduction as 1 daily examine the school-children. Many of 
these children are underweight for several reasons, lack of sufficient rest, 
etc., but principally from years of unbalanced diet. It is the same old 
story — too much sugar, too little fat, and too much protein. For this 
reason I advise much cod-liver oil, not as a medicine hut as a food which 
will raise the fat percentage. The high percentage of sugar which 
children obtain is due to candy, white bread, cakes, polished rice, too 
many potatoes, white flour, etc. It is amazing to find the number of 
children and adults who do not like whole-wheat bread, eggs, milk, nuts, 
cheese, vegetables), fruit, etc. All of these are nature's protections from 
sickness and disease. But where the value of these foods has been 
recognized we have had wonderful results with underweight children. 

The children themselves are so keen on gaining and I find they have 
splendid co-operation with their parents. They really are getting more 
of these natural products of the soil, and now we are getting results. 
One little girl gained 5 lb. in two weeks and has been gaining steadily ever 
since. Another child, a hoy of 13 years, gained 8 lb. in two months. 
Their teachers tell me these children are improving in their school-work. 

I have started giving weekly health talks to the high-school girls. 
Later we will form Little Mothers' League classes/. Home-visiting has 
become a great pleasure as one receives such a warm welcome from the 
mothers. I have also started evening health lectures for parents and 
adults at the high school. These are held twice a month and are well 
attended and a great joy to us all. They are really get-together meetings) 
for people who are interested in the welfare of the child, our nation's 
greatest asset. How many of us realize that our strength as a nation 
depends on our moulding and building of these children? The children 
of to-day are our future generation. Surely we need healthy, happy 
citizens to carry on the progress of our Canada. 

Olive M. Garrood, E.N, 



PEOGEESS IX EUEAL PUBLIC HEALTH NUESING. 

Progress in public-health nursing is not noticeable from day to day, 
nor yet from month to month, but there is growth and it can be measured 
with the years. 

The foregoing is brought home to me when I look back over the last 
four years, which, with the exception of the last few months, 1 spent at 
the Cowichan Health Centre. On my arrival I found the nursing staff 
to be two nurses domiciled at a very second-rate hotel, though the charge 
made should have been sufficient, in my opinion, for comfort at least. 
Well do I remember the staff nurse and myself starting out to look for 
rooms. We made a canvass, almost house to house, finally locating a 
kind-hearted woman who had two empty rooms over her shop and who 

2.°> 



was prevailed upon to permit us to furnish the rooms and become her 
tenants. Some six months later we moved into a steam-heated apartment 
block, which was newly constructed in a business section of the town, 
and a little over a year ago the move was made into a large house on the 
main road, which is now the home of the Health Centre. The office during 
this time has been on the second flood of a store building, it being possible 
to make arrangements to have the telephone answered when the nurse was 
out in the field. The move into a building of our own was to my mind 
the most progressive step made; not only did it link all our activities 
under one roof, doing away with the difficulty of procuring adequate 
boarding accommodation, but the effect on the public was interesting; 
the Cowichan Health Centre became a real part of the community life, 
and I think always will be. 

The different activities of the Health Centre have grown tremen- 
dously, and at sometimes unexpected angles ; as, for instance, a Women's) 
Institute group last year asked if they might 'be given instruction in home- 
nursing, their request being followed by similar ones from three other 
Women's Institutes in the district. What better opportunity is there for 
health-teaching than to such a group meeting for at least twelve classes. 
The staff was increased and a second car deemed necessary in order to 
meet, the increased demand made on all branches of the service. 

Can this progress be accomplished by the nurses alone? Indeed no; 
a whole-hearted effort on their part is most certainly necessarv, and vet 
we seldom pause to consider how little can be accomplished without the 
interest and support of the community as a whole. In public-health 
nursing we feel that we cannot accomplish very much without the co-opera- 
tion (a wonderful word, which should mean the working together for the 
common good) of the mothers, the children, and, in our school-work, the 
teachers. We ask them to co-operate with us in what we consider to 
be the best interests of themselves and their children, and vet at the 
same time do we make any great effort to co-operate with them? In 
order to get the best results we must make an effort to see each other's 
point of view. We who have been teaching the benefits of public health 
for years jump to the conclusion that because parents and teachers are 
not interested at once in what we know to be for their benefit they are 
unwilling to work with us. If, however, we proceed very slowly and 
endeavour to acquaint them with what to us is very natural and necessary 
knowledge, we will in time have results that are encouraging and often 
far-reaching. 

I think we often take ourselves too seriously, more especially the 
nurse working alone in her district. She is very often apt to become 
discouraged, as progress to her seems very slow, forgetting that after all 
she is just a part of the organization, and what may seem to her very 
little advancement in her particular field added to the progress made in 
similar districts all over the Province can be viewed as very splendid 
progress indeed, the credit not being due to any one individual, but to 
the staff as a whole. 

ISABELL M. GlBB, 

Duncan. 
24 



COWICHAN HEALTH CENTRE. 

The accompanying "Notes for the Guidance of Public Health 
Nurses " were written, on request of the Provincial Board of Health, by 
Mrs. M. Moss, President of the Public Health Committee in charge of 
the Cowichan Health Centre. 

The success of the work as carried out in Cowichan under the gui- 
dance of the local Health Committee has been very gratifying, and it was 
thought that a statement of the plans adopted and carried out by the 
lay committee would be of moment to the nurses practising and in 
training. 

We wish to take advantage of this opportunity of expressing our 
appreciation of the splendid co-operation we have always received from 
the Health Committee of the Cowichan Health Centre. 

Notes for the Guidance of Public Health Nurses. 

(1.) Health Ventre. — A Health Centre (such as Cowichan or Saanich), 
is an integral part of the Public Health Department and the nurses 
employed are members of the Public Health Nursing Staff, whose head is 
the Provincial Health Officer. 

(2.) Local Committee. — These nurses work under a local committee, 
who are responsible for the financial and general superintendence of the 
Health Centre. The relations between the nurses, committee, and the 
Public Health Department are analogous to those existing between 
teachers, School Boards, and the Education Department. The committee 
leaves the professional side of the work to the nurses, who communicate 
direct with the Public Health Department. 

(3.) Appointment, Salaries, etc. — All appointments and dismissals 
are made by the local committee with the knowledge and approval of the 
Provincial Health Officer. All salaries are paid by the local committee. 
On the request of the Public Health Department, and with the consent 
of the local committee, a nurse may be transferred from one district to 
another on promotion, or for the general benefit of the Public Health 
Nursing Service. 

(4.) Public Health Xui'se's Position. — The position of a Public Health 
Nurse is pre-eminently an important one in a district and calls for high 
professional ability, high ideals as a public servant, and infinite tact. 
The first impressions made by a nurse on the committee and district are 
almost indelible, and nurses should realize that professional and social 
etiquette must be strictly observed in many directions if they are to 
uphold the dignity of their calling and the prestige of the Public Health 
Department. 

(5.) Financing of a Health Ventre. — So many organizations are 
affiliated in the work of a Health Centre that the wise nurse will make 
herself thoroughly acquainted with the financial side of the work. The 
upkeep of a Health Centre is financed by grants from: — ■ 

(a.) The Public Health Department. 
(I).) The Education Department. 
(c.) Local School Boards. 

25 



((].) City and Municipal Councils. 
(c.) Women's organizations. 
('/.) Nursing fees. 

((/.) Membership fees of the general public interested in public 
health. 
(G.) Taking-over qf Dirties. — On her appointment a new nurse should 
be given at least one week to lake over her duties from her predecessor. 
She will meei her committee and be given a general outline of the work 
of the district. The retiring nurse should, as far as possible, introduce 
her to the local .Medical Health Officer, school doctor and dentist, head- 
masters and mistresses of the local schools. Special attention should be 
given to serious nursing cases and bedridden patients should be visited 
and the new nurse introduced. 

(7.) Office-work. — The office routine should be explained. All school 
records, Metropolitan insurance-books, account-books, etc., should be 
brought n]> to dale and handed over officially. An inventory of all office 
furniture, books, paper, supplies, etc., should be made and, if found 
correct, signed by both nurses. 

(8.) The Motor-car. — The condition, age. licence, insurance, and 
garaging of the motor-car should be thoroughly explained by the outgoing 
nurse, and when satisfied thai all is correel the new nurse should sdgn the 
necessary forms provided by the committee for handing and taking over. 
(9.) -1 New District. — In the event of a nurse opening up a new 
district, she will be guided by her committee as to local conditions, but 
as soon as possible she should call professionally upon the following:— 
(a.) Medical Health Officer. 
{!).) Local doctors and dentists. 
(c.) Headmasters and mistresses of schools. 
(d.) Clerks to School Boards. 
(c.) Metropolitan insurance agent. 
(/.) Matron of local hospital. 

{().) Presidents and secretaries of Women's Institute and other 
organizations. 

M. .Moss, 
President, Cowichan Health Centre. 



VICTORIA, B.C. : 
Printed by Chakles F. Bantield, Printer to the King's Mosl Excellenf Majesty. 

1928. 



500-428-1506 

26 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 APRIL, 1929. No. 6 



EDITORIAL. 

A S PUBLIC HEALTH NURSES we hear a great deal about " keeping 
fit," generally applied to our physical well-being. What about 
"keeping fit — mentally"? A difficult proposition for a Public Health 
Nurse at any time and under any circumstances, but very hard indeed for 
the nurse working alone in a rural community. The nurse working alone 
is the real pioneer in the service; many a large public-health service has 
been built on the foundation laid by the individual nurse working under 
great difficulty to carry out a wisely planned programme. 

Association with others of her chosen profession is perhaps what a 
nurse working alone misses most, especial!}- if she has just recently left 
either her training-school or university. The nurses she comes in contact 
with are either institutional or private-dtity workers, and of course their 
view-point as to the value of public-health teaching may be very different 
to her own. At the same time, this association with other nurses should 
be encouraged, as aside from being very pleasant socially, often is a great 
stimulant to thoughtful discussions of the value of the service to the people 
of the district. 

Public-health publications of all kinds are of great benefit to the 
Public Health Nurse ; the number a nurse should subscribe for regularly 
is limited to the amount she feels justified in spending. Perhaps no two 
nurses agree on just what publication is of greatest assistance to them 
personally. Generally speaking, a nurse does obtain the greatest benefit 
from a magazine published monthly which deals with the subject in which 
she is most vitally interested. 

Very few Public Health Nurses can afford to purchase for themselves 
reference-books which they feel may be of assistance to them in their work, 
and yet many times do they feel the need for such books and are unable to 
obtain them from any library to which they may have access. Realizing 
this difficulty, the Public Health Committee of the British Columbia 
Graduate Nurses' Association have accepted the offer made them by the 
Provincial Library Commission to place an " Open Shelf " in the library 
at Victoria at the disposal of the nurses of British Columbia. 

A number of books which are of interest to Public Health Nurses 
particularly are being purchased, and it is hoped to have them placed 



very shortly on the " Open Shelf," so that they will be available for the 
nurses of the Province. The initial number of books available will not 
be large. It is hoped the nurses will find them very interesting, so inter- 
esting that they will use them constantly, thus proving to the sceptical 
ones (some of these sceptics being public-health workers themselves) that 
the majority of the Public Health Nurses of British Columbia are anxious 
to keep abreast of the times in their own particular field at least. 

The offer made by the Provincial Library Commission is a very 
generous one, for they are willing to place at the disposal of the nurses 
this " Open Shelf," on which will be placed the books handed over by the 
British Columbia Graduate Nurses' Association, the Provincial Board of 
Health, or any one interested; to add new volumes from time to time as 
the nurses themselves demonstrate their interest in the library; also they 
are willing to pay postage one way, the individual borrowing the book to 
pay return postage. A bulletin giving a list of books available and their 
authors will be mailed to all Public Health Nurses in the Province. 

Realizing that public-health nursing is an interesting and all-absorb- 
ing profession, it is not surprising that Public Health Nurses, in an 
endeavour to keep pace with the progress of their profession, lose sight 
of the fact that in order to keep tit mentally it is necessary to keep in 
touch with what is happening in the world outside their own particular 
sphere. Remembering this, an effort should be made to attend on all 
possible opportunities lectures on topics of general interest, recitals, 
concerts, and other entertainments that may be given in their district. 
A subscription to a publication of general interest will add greatly to 
their pleasure and interest in life, thus increasing the Public Health 
Nurse's efficiency in handling the problems that crop up in her daily life. 

ISABELLE M. GlBB. 



CI- 



TABLE OF CONTEXTS. 

Page. 

Editorial. By Isabelle M. Gibb - - - - 1 

School Nursing. By Elizabeth Breeze -— 4 

The Public Health Nurse. By P. Charlton..... 6 

Care of Baby. By Kathleen Crozier 7 

Post-graduate Work at Columbia University, New York. By 

Margaret E. Kerr 8 

My Impression of Public Health at Saanich. By Mvrtle Harvey.... 10 

Sayward, Vancouver Island. By Edith M. Walls „ 11 

" Class-instruction " Qualicum and District Public Health Associ- 
ation. By Margaret M. Griffin __ 12 

Cowiciian Health Centre. By M. Claxton 13 

Oliver, Okanagan Falls, and Osoyoos. By M. A. Twiddy ..-.. 11 

The Home School Visit. By Esther Naden 14 

The Cowiciian Dental Clinic. By A. Yates .'. 16 

The Organization of Public-health Work in the Kelowna Rural 
Districts. By Anne F. Grindon 17 

Esquimalt Rural Nursing Service. By Helen Kelly _ 19 

Vernon. By E. Martin — ... 21 

Public Health in Naxaimo. A. Verna Berkley _. 22 

The Value of Pre-sciiool Work. By Nora Higgs 23 

Health-work in Port Alberni. By Mary E. Grierson..... 24 

Ladysmitii. By II. Peters 25 

School Nursing in Kelowna City Schools. By Frances Lyne 2(> 

Public-health Work in Kam loops. By Olive M. Garrood 2!) 

Public-health Nursing ix Keremeos. By Kathleen Snowden.... — 31 

Co-operation. By Norah E. Armstrong- 32 

Tuberculosis-work in British Colu.mf.ia. By Josephine B. Peters.... 33 

School-work in Fernie. By Winifred Seymour _ _ 34 

Personals 35 



SCHOOL N'UKSING. 

Now that medical inspection of school-children, or, as it might be 
more correctly termed, health supervision of school-children, has been 
carried on for a number of years, we are reaching the point where we feel 
that an attempt to evaluate results is warranted. 

When medical inspection of school-children was first established, its 
main purpose was the control of contagion; later was added the physical 
examination for the detection of remediable defects; while these two 
objectives are still prominent, a third and a most important has evolved, 
that of health promotion by means of education in healthy living. 

We are reminded that public health has in its development passed 
through three eras. The first, beginning about one hundred years ago and 
lasting thirty or forty years, was the era of suppression of disease and 
was based on the theory that illness was caused by filth. This might be 
termed the age of sanitation. Following this was a period of disease- 
prevention, when greater efforts were made t# control the environment 
and regulate the movements of individuals when they affected the public 
health. The third era has only just begun. It is an era not only of the 
suppression of disease through sanitation and of disease-prevention, but 
includes the education of individuals on personal hygiene and rules of 
right living and in health promotion. In the present-day conception of 
public health the school-health service occupies a most prominent and 
important place. Through its specially trained health-workers the school- 
health service is able to bring to the children, the teachers, the parents, 
and the community expert information in the three fields necessary for 
public health — namely, sanitation, preventive measures, and personal 
hygiene and health promotion. 

Can we truly say that health supervision of school-children is showing 
results, and is accomplishing those things which it set out to do in the 
prevention of contagion — the detection and correction of physical defects 
and education in healthful living? Measuring the results of health- 
promoting activities is difficult, but perhaps a few figures from the report 
on the Vancouver City schools, as they afford the largest group and as a 
system of health supervision has been established for a number of years, 
might be considered. The records show a stead^v decrease in the number 
of children found with physical defects of various kinds. For example, 
in the last few years, malnutrition has shown a decrease of 10 per cent.; 
enlarged tonsils, 25 per cent. ; defective vision, 25 per cent. ; and defective 
teeth, 33 per cent. What is making the difference? We think that the 
answer can be found in the growing realization on the part of parents, 
teachers, school officials, and the general public, through health education, 
of the importance of knowing and applying the principles of sanitation to 
home and school environment, of the use of modern methods for preven- 
tion of disease, and to the education of individuals in personal hygiene. 
It is resulting in the saving of thousands of dollars to the ratepayers 
through saving of school-time, not only by preventing loss of school-time 
through preventable illnesses, but also by the increased ability of the 
children, through improved health conditions, to take greater advantage 

4 



of the facilities provided. It is a well-known fact that children suffering 
from various physical defects constitute a large percentage of the 
" repeaters " in schools. In addition to this is the time saved by the 
prevention of the spread of contagious diseases by the early detection and 
isolation of infected children, which can only be done by trained health- 
workers. By this means others are protected from infection and illness 
prevented which might cause not only a loss of school-time during the 
active course of the disease, but also be followed by after-effects resulting 
in poor health and lowered efficiency in later years. A year ago certain 
regulations in connection with the control of infectious diseases were 
issued by the Provincial Board of Health, which are applicable only in 
communities in which an adequate school-health service is maintained. 
After operating under these regulations for three and one-half months, 
it was found that in the Vancouver City schools 00,000 school-days at an 
approximate cost of |18,000 had been saved. At the same time results 
proved conclusively that a maximum amount of protection had been given 
the pupils in the schools. 

Through the activities of school-health workers, many harmful envi- 
ronmental conditions in school, such as improper lighting and ventilation, 
unsanitary and inadequate lavatory and toilet accommodation, and other 
unhealthy conditions, have been brought to the attention of the authorities 
and remedied. Special classes for handicapped children, such as open- 
air classes for delicate children, sight-saving classes for those with im- 
paired vision, remedial classes for the correction of postural defects and 
deformities, special instruction and care for undernourished children, 
and dental clinics, have been established, all contributing to the improve- 
ment of child-health. 

The importance of healthy children to the community and to the 
nation has been too often demonstrated to be doubted, and no effort is too 
great which will bring about this objective. The promotion of health is 
work for the community, for parents, teachers, and the children them- 
selves, and for co-ordinating their work and stimulating their efforts the 
Public Health Nurse, with the school as the centre from which her efforts 
radiate is essential. School-health work is a part of the great modern 
public-health movement; and what is public health? We cannot do 
better than quote the definition given by Dr. G. E. A. Winslow, Professor 
of Public Health in the Yale School of Medicine, who says : " Public health 
is the science and the art of preventing disease, prolonging life, and pro- 
moting physical health and efficiency through organized community efforts 
for the sanitation of the environment, the control of community infections, 
the education of the individual in principles of personal hygiene, the 
organization of medical and nursing services for the early diagnosis and 
preventive treatment of disease, and the development of the social 
machinery which will ensure to every individual a standard of living 
adequate for the maintenance of health ; organizing these benefits in such 
a fashion as to enable every citizen to realize his birthright of health 
and longevity." 

Elizabeth Breeze, K.X., 
Head Nurse, Vancouver City Schools. 



THE PUBLIC HEALTH NURSE. 

Public health is not new, but during the past twenty years it has 
developed greatly. However, there is still a growing field, and a field in 
which the public is realizing to an increasing degree the value of effective 
work. 

The nurse has been an indispensable factor in public-health service. 
She is a. link between the school and the home, the community and the 
home. She, it is, in many cases who has the responsibility of getting over 
into practice the principles of the new gospel of health-teaching and 
breaking down old prejudices. 

The attitude of the nurse toward the parent and the home is vital. 
If .she is to be a success a friendly relationship must be established. How 
often one feels an antagonism which gradually becomes less after one or 
two home visits until there is a feeling of friendliness. This friendly 
feeling when once established has considerable value in gaining the 
parent's co-operation. Very often the attitude of the child towards the 
nurse and toward health-work helps or hinders accomplishment in the 
home. 

The nurse has made school medical work truly effective. Her activi- 
ties in the discovery of physical defects and in gaining the co-operation 
of the parent in having them corrected are important phases of the work. 

In lighting tuberculosis, as well as in preventing other communicable 
diseases, the nurse can play an important part. She must not only be 
grounded in the care of the actively tuberculosis patient and keenly 
sensitized to her responsibility for the protection against the disease of 
all members of the patient's family, but she must constantly be on the 
alert to prevent the occurrence of the disease in susceptible or pre- 
disposed individuals. Through her contact with the children in the 
school and the parent in the home she becomes familiar with home con- 
ditions and environment. After finding out all the positive cases in the 
community she can keep a close watch on the contacts. Children suffering 
from malnutrition and other defects are also carefully observed, and she 
sees these children have periodic examinations and emphasizes the neces- 
sity of healthful living. Tuberculosis is a disease to be conquered or 
prevented only by the regular and persistent practice of proper health 
habits. 

In recent years since better and more complete census reports have 
begun to be made have people become aware of the overwhelming total 
of* yearly deaths of mothers and infants. It has always been recognized 
the maternal mortality in childbirth is preventable. Florence Nightingale 
said: "Lying-in is neither a disease nor an accident, and any fatality 
attending it is not to be counted as so much per cent, of inevitable loss. 
On the contrary, a death in child-bed is almost a subject for inquest. It 
is nothing short of a calamity which it is right we should all know about, 
to avoid it in the future." What was true in Florence Nightingale's day 
is doubly true in ours. The Public Health Nurse can do a great deal in 
lowering this appalling death-rate. Persuading the prospective mother 
in the early stages of pregnancy to obtain a physician's advice might 

G 



prevent the catastrophe of a motherless home. The nurse can also teach 
her how to guard her own health, so that when the baby comes it is 
endowed with the richest of all heritages — health. 

After the baby comes, the mother, especially with her first-born, needs 
expert advice in the care and feeding of her infant. She should be advised 
on the importance of breast- feeding, which should be firmly established. 

The nurse in the community should see that the 'teen-age girls have 
instruction in child-care. The girls of to-day are the nation's future 
mothers. 

The duties of the Public Health Nurse are many and varied. Pre- and 
post-natal work, infant and child welfare, bedside nursing, tuberculosis- 
work, the prevention of communicable diseases, and teaching health are all 
a part of her programme. 

P. Charltox, 

Armstrong, B.C. 



ARMSTRONG. 

The following essay will show the results of the teaching as conducted 
in the health classes. The writer is a girl of 13 and the essay is her inter- 
pretation of the lessons received from the Public Health Nurse. Health 
habits have been implanted in this child. Is it not worth while? 

CARE OF BABY, 

Nearly every one loves babies, so they would not want the baby to be 
unhealthy because of improper care. For the first few months baby does 
nothing but eat, sleep, and grow. 

The baby's clothing calls for great care. It should be suitable to the 
season, neither too warm nor too cold. When baby is taken outdoors the 
clothes should be warmer than usual. They should all be made to open 
down the front and the weight to hang from the shoulders. The vest 
might be of silk and wool, which is better than pure wool. When wash- 
ing the clothes, never starch them, but wash in warm water with some nice 
soap. Do not blue the diapers. 

The young baby's food consists mostly of mother's milk, but as he 
grows older other foods may be added. From an earlv age baby should 
have orange or tomato juice every day as well as cod-liver oil. 

Sleep is Nature's way of resting the body, and the younger a child is, 
the more sleep it needs. A young baby should sleep at least nineteen 
hours out of the twenty-four. When possible baby should sleep alone. 
Baby should not be allowed to sleep with a bottle or a pacifier in its mouth. 
The room in which he is sleeping should be screened, cool, well ventilated, 
and free from flies. 

When preparing to bath baby be sure to have everything ready. The 
clothes may be put out on the table ready for putting on baby afterwards. 
All necessary articles, such as soap, powder, towels, vaseline, and boraeic 
acid, should be put on a tray near at hand. The temperature of the room 
is about 70° and the bath-water about 9S°, or body-temperature. Have a 

7 



separate towel and wash-cloth for the face and body. Never leave baby 
in the bath very long as he may catch cold. 

Play is good exercise for all babies. Toys should be given that are 
washable and too large to be put easily in the mouth. Baby can be put 
on a bed with just a few clothes on each day, so as to kick and strengthen 
the legs and arms. 

Fresh air prevents colds and should be indulged in at an early age. 
In the summer take baby outdoors for a walk or put the carriage in a 
shady place and screen from the flies; then allow baby to sleep quietly. 
In the winter take him outdoors if possible, or, if not, dress him in his 
outdoor clothes and open the doors and windows for an hour or two. 

Begin to train baby to good habits when he is young. Bad habits are 
easy to form but hard to break. One of the worst habits is persistent 
crying when all baby's wants have been seen to. To break it, first see to 
all baby's troubles; then let him cry himself to sleep. A pacifier is bad 
for baby as it is both dirty and dangerous, often spoiling the shape of the 
mouth and causing adenoids. 

To kiss a baby on the mouth is neither clean nor desirable. When 
carrying baby always support his head and back. Do not lift him up by 
the arms. 

The nursery should be a large, well-ventilated room, screens on all 
windows and doors. The lights should be protected and out of baby's 
reach. Everything from the curtains to the floor and furniture should 
be plain and easily kept clean. White is the best colour for the furniture. 
Shelves may be put along the sides for baby's toys. The temperature 
should be kept even at about (55° to 08°. 

Kathleen Crozier, 

Age .13, Armstrong, B.C. 



POST-GRADUATE WORK AT COLUMBIA UNIVERSITY, 

NEW YORK. 

In choosing a subject upon which to write, I am confronted by so vast 
an array of public-health agencies, all doing good work, much of it new, 
experimental Work, it is difficult to determine what would be most inter- 
esting and valuable. There is the splendid work of the Henry Street 
Visiting Nurse Service, of which we all heard while taking our courses 
at the University; the Maternity Centre Association, which does a tre- 
mendous volume of the maternity-work. When it is remembered there 
are approximately 125,000 babies born in New York City every year, of 
whom probably 50 per cent, are born in institutions, it will readily be 
understood what demands will be made on an organization of this nature. 

In 1924 the American Red Cross, Henry Street Maternity Centre, and 
the Association for Improving Conditions of the Poor decided to merge 
their activities in a given area of the city, for a period of a few years, 
in order to experiment with the value of generalized versus specialized 
services. A total annual sum of |G5,000 was contributed and the East 
Harlem Nursing and Health Demonstration was established. 



The budget thus secured provided what was probably a larger sum 
than had been available hitherto for public-health nursing in an area of 
equal size and population. The Demonstration was therefore an experi- 
ment in the co-ordination of nursing activities, with sufficient funds for 
the development of a programme approximately adequate to community 
needs. 

In a district such as that in which the Demonstration is located, 
clinics for the health examination of children and adults is indispensable. 
To supplement the work of the Public Health Nurse, definite provision 
was made for the inclusion of a programme of nutrition-work with the 
nursing and medical services. 

The Demonstration planned to lay special emphasis on experimenta- 
tion in fields that had hitherto been somewhat neglected, particularly in 
health-work for the pre-school child. As that is one phase of our work in 
British Columbia that has not received its full due of attention, a brief 
account of some of their procedures might be of value. 

Three rooms have been provided for the clinic — one, for the doctor; 
one, a consultation and demonstration room for the adults to talk to the 
nurses or nutrition-workers; and the third, a waiting-room. In the last 
room are the " aids," girls who are paid a regular though small salary to 
come and look after the children while they are attending clinic, take 
cases to hospital, set up the equipment, etc. 

The rooms are a distinct departure from the uniform white walls of 
the average clinic. The walls have been tinted in harmonious colours; 
pretty, daintily made, coloured curtains cover the windows. The rooms 
are made just as attractive as possible to serve as models which the 
women frequently copy at home. There is nothing at all pretentious about 
any of the rooms. The whole purpose is to set mothers and children at 
their ease immediately. 

There is a large personnel in attendance at each clinic to ensure 
adequate educational work. The same quarters are used for the prenatal, 
infant, and pre-school clinics. The average attendance at each will show 
six to seven prenatal examinations made, or fifteen to eighteen infants 
examined, or twenty to twenty-five pre-school children cared for in the 
course of one clinic. They have established the practice for the nurse 
to do all the vaccinating for smallpox and to give the toxin-antitoxin 
treatments, but only when the doctor is present. 

From experience they have found that to secure the best results from 
their physicians, voluntary service is eliminated entirely. Accordingly, 
the doctors are carefully selected for each clinic and receive a regular 
salary of $4 to $5 an hour. They have found it is wise to pay him even for 
occasional days, when because of a holiday no clinic is held. They have 
estimated that each type of clinic costs from $800 to $1,000 a year! This 
includes all items excepting the nurses' salaries. Will it not be a grand 
day when we can estimate even an approximate amount for our clinics 
in British Columbia? 

In the waiting-room on the pre-school clinic days is a set of equip- 
ment guaranteed to bring joy to the heart of any youngster — big blocks, 
balls, crayons, cut-outs, books, beads, etc. Frequently an elder sister 

9 



accompanies the child to the clinic. This is especially true for the Satur- 
day morning one. These hig girls are taken in hand by the nutrition- 
worker, who teaches them simple lessons in preparing food for the little 
ones of the family. 

I was particularly interested in the methods employed for testing the 
eyes of these little preschool people. The Snellen " E " chart is used 
rather than any of the pictograph charts, though they are at hand also. 
.V regular game is made of the test. In fact, at no time is it mentioned 
that the eyes are being tested. 

The game is never hurried. That is one point that is always stressed. 
Because a little child is apt to become confused when attempting to con- 
centrate on one letter when it is mixed np among a lot of others, a piece 
of dark cardboard, large enough to reach across the width of the chart, 
and with a small square cat in it, is placed over the chart so that eacli 
letter appears to be in a tiny box. The children may not understand all 
the directions, but they love to show which way the " legs" of the "E" 
point 

It has been found the children become less fatigued if a routine of 
first the right eye, then the left, is always followed. Any abnormal 
conditions, such as frowns, scowls, squinting, holding head on side, stooped 
shoulders, or an irregularity in the way the eyes focus, are noted. 

When there is any reason for the child to go to the ophthalmologist, 
he is always ready to go to show the nice man how well he can play the 
game. About 10 per cent, of the children have been found to require 
glasses. They arc 1 never advised for these small children except when 
absolutely necessary to protect vision or to prevent more serious develop- 
ments. 

Margaeet E. Kerr, K.N. 



MY IMPRESSION OF PUBLIC HEALTH AT SAANICH. 

Not long ago I had to make a decision. "Which of the two courses 
offered the tilth-year nursing students of the University of British Colum- 
bia would I take — teaching and administration or public health? My 
hospital training had shown me what could be expected from the first, 
but nothing, up until the time I had to make my decision, had been revealed 
about the last. Public health, therefore, remained a mystery to me, and 
the fascination that most people have for mysteries influenced my choice. 
Gradually, then, 1 realized* the extent of the aims of public health; that 
the preventive side of medicine is to be stressed with the idea of " keeping 
well people well." This truly was very different from my former views of 
nursing. 

Still intent on finding out more about these new ideas, I came to 
Saanich Health Centre, and since then have found that a public-health 
programme is not as easily carried out as the enthusiastic text-books and 
various types of literature lead the inexperienced student to believe. 

The main difficulties that I have met in Saanich have arisen from a 
public not educated to the facts that the nurses are not solely curative 
agents, and that the staff of nurses must be increased as the bedside 

10 




nursing increases in order to adequately carry out a public-health pro- 
gramme in conjunction with it. Time changes all things and the results 
of public health as compared with the results of curative nursing are 
seen only as time goes by. Therefore, bedside nursing, instead of decreas- 
ing as it shouuld through preventive teachings, is still very much on the 
upward grade. Patients once becoming familiar with the home-nursing 
service will not only call the nurses time and time again, but will also 
tell their friends, and unless the staff of nurses is increased accordingly, 
the public-health programme of necessity has to be neglected. Then, 
again, a great deal of time is spent nursing chronics. Some months the 
number of chronic nursing cases constitutes nearly 50 per cent, of the 
total nursing cases. That the people as a whole in Saanich appreciate 
the nurses more because of their curative rather than their preventive 
value has come as an almost startling revelation to me. Because the 
public is always grasping for something tangible, it is hard to make it 
realize the value of public-health nursing. 

However, in order to arrive at a reasonable solution of this " mystery," 
the absolute requisite of any mystery — time, preseverance, and patience — - 
must be exercised, and I, the veriest of beginners in public health, will 
hopefully await results. 

Myrtle Harvey, R.N., 

Saanich Health Centre. 



SAYWARD, VANCOUVER ISLAND. 

It is with much pleasure that 1 submit a small article for this year's 
Bulletin. 

Taking the year all round, the health of the school-children has beer 
good up to February, when most of the children have been absent owing 
to severe coughs and cold, rather more severe than usual. 

The frosty weather in British Columbia does not seem so healthy as 
the wet weather, but the children all seem to be recovering now, apart 
from the common colds. The children are very fortunate, for during my 
eight years' residence in Sayward there have been no infectious diseases. 

The dentist was in the valley last August and through the help of the 
Provincial Board of Health attended to all the school and pre-school 
children's teeth, many of the residents also taking advantage of his visit 
to have work done. 

I have also had a supply of useful and instructive literature for 
children and mothers from the Department and distributed same at 
various times. 

Several expectant mothers have had and enjoyed reading the pre- 
natal literature and letters supplied on request. 

The Upper Sayward School 1ms started a " Junior Red Cross " lately 
and seem very enthusiastic over it. They enjoy reading the monthly 
letter and book sent out. 

They gave a whist drive and dance and realized a few dollars, some 
of which they are sending to the Junior Red Cross for the Solarium. 

11 



3 



The usual annual fair was held in September. The school-children's 
entries made a very good showing and there were several prizes taken 
among them. 

I would also like to add a word of thanks to the Provincial Board 
of Health for their help and advice to me when I am in any doubt, also 
to Drs. Stringer and Mills, of the Columbia Coast Mission, who I can 
usually reach by telephone if I want any advice in regard to removal or 
treatment of a patient. 

Edith M. Walls. 



QUALICUM AND DISTRICT PUBLIC HEALTH ASSOCIATION— 

CLASS-INSTRUCTION. 

Since my arrival in this essentially rural district I have been rather 
surprised and very gratified at the keen interest evinced by both children 
and adults in educational work as a means of prevention of disease. 

I think all will agree with me when I say that the average Public 
Health Nurse, fresh in the field, dreads the very thought of giving class- 
instruction. I shall never forget how my knees shook and how very far 
distant my voice sounded when I gave my first health-talk to a class of 
school-children. What a sigh of relief when the ordeal was over! And 
yet it had to be done, for is not education the first step in prevention? 
My experience is that repetition is the only means of banishing this form 
of stage-fright, and one grows to enjoy rather than abhor instructional 
work. 

In my district the majority of the boys and girls have not had the 
benefit of the training which is accorded to Girl Guides and Boy Scouts — ■ 
even the elementary first-aid which aims at making them cool and 
observant in emergencies and dexterous in the application of their knowl- 
edge. For this reason I organized a class among the senior pupils of 
French Creek School and gave a course of twelve lessons. All attended 
regularly and showed keen interest and proficiency. 

In times gone by, in cases of communicable disease, the cry was: 
." Children must have it; let them get it while they are young and be done 
with it." But with what dire results ! Now, fortunately, the majority 
of mothers are beginning to realize that all communicable diseases are 
prevention. '"But how; and what are the first symptoms?" one hears 
on all sides. What better way to reach the majority than by class-instruc- 
tion, especially as it gives rise to much desirable discussion? 

We all realize how essential it is to have the patient intelligently 
cared for in the absence of the nurse. It is surprising how few untrained 
women know how to apply even a simple fomentation. Suppose the 
doctor has ordered hot fomentations for a suppurating finger — on goes a 
messy bread-and-milk poultice! It is not infrequent to hear of a strained 
back " because when father was ill he was too heavy for me to lift "■ — 
when all she needed was to have been shown the knack of turning a 
patient. There is so much that can be taught by means of organized 
home-nursing classes; many can be reached in this way who could not 
have individual instruction, as the average nurse is far too busy. 

12 



Think of the confidence that can be instilled into the potential mother 
by the aid of Little Mothers' classes. How many bitter tears for the 
parent and injuries to the infant could be avoided when the young mother 
bathes her baby for the first time ! 

I find that a set course of lessons, with practical demonstration, 
given regularly, is of much more value than those given sporadically. 
Instructive work is such a worth-while phase of our life as Public Health 
Nurses that it should occupy a greater portion of our daily routine than 
it does at present. We are repaid many times for our trouble when 
statistics slowly but surely show a decline in physical defects and deaths 
which are well known to be so largely preventable. 

Margaret M. Griffin, E.N., 

Errington, V.I. 



COWICHAN HEALTH CENTKE. 

I suppose most of us who are active in the field of Public Health are 
from time to time surprised and somewhat shocked at the ignorance still 
shown by many people of our work, our aims, and ideals ; in short, our 
raison d'etre. By many we are still looked upon simply as " the district 
nurse " — busy, no doubt, when there is much sickness about, but at other 
times probably leading a fairly easy life, waiting about for calls! They 
do not realize that we might be more consistently busy if we had no 
bedside-work at all, as then we should be able to arrive at a fuller and 
more regular programme of educational work. But the needs of the 
community in this respect have to be met, and, after all, the bedside 
visit has its uses from the educational standpoint too. 

Of course, time and education are gradually changing this view-point, 
but what can be done to hasten the process? We do want the people to 
get hold of that idea " prevention." Too often, much too often still, do 
we hear the fond parent say : " When he's sick I'll take him to a doctor ; 
that's soon enough " ; and so we see the child gradually acquiring ill- 
health from defects unremedied, or the infant becoming an undernour- 
ished or rickety child through a faulty diet. However, we must not 
despair, but peg away and have patience. Publicity, and more publicity, 
is what we want — access into more and more homes. 

This publicity is achieved to a large extent, of course, by talks to 
different groups, such as the Women's Institutes, the Parent-Teacher 
Associations, and student nurses ; but then there are a great many people 
who belong to no organizations and never attend meetings of any kind 
and have no time for reading. These can only be reached by actually 
visiting them in their homes. Every new home to which we have access 
is a fresh opportunity. For this reason we like to visit as many parents 
of school-children as possible, even though there is no actual defect to 
bring to their notice. To every home where there is a young baby we 
have that never-failing '"open sesame" — the scales! What mother can 
resist them? And then having weighed the baby and discussed its feed- 
ing, all sorts of little matters concerning the health of other members of 




the family may be brought up, and we get a good chance to explain our 
work and what we aim at doing. 

The value of the scales as a publicity agent was also brought home to 
us at the last fall fair in Duncan. We had an exhibit showing the three 
main branches of our work, and of these there is no doubt that the infant- 
welfare section proved the chief drawing-card. Here we had our baby- 
clinic scales, and a nurse present to weigh babies and give advice on their 
care to any mother who liked to avail herself of the opportunity, and to 
learn of our child-welfare service. We found many interested mothers 
and fathers and took the names and addresses of several new babies to be 
followed up. 

And so, opportunities of getting the idea over to the people come to 
us in many different ways, and the great thing is for us to be always on 
the alert not to let any of them slip, for if much seed is sown, surely some 
will hear fruit. 

M. Claxton, E.N., 

Duncan. 



OLIYEE, OKAXAGAN FALLS, AND OSOYOOS DISTRICT. 

Since the district was only opened on November 26th, 1928, there is 
very little to report. The area covered extends from Okanagan Falls 
southward through the fruit country at Oliver and on to Osoyoos, a 
distance of about 28 miles, including the Indian reserve 8 miles east of 
Oliver and scattered ranches at White and Green Lakes. 

The roads are nearly all gravelled and passable most of the year, 
making transportation easier than in some districts. We get about in 
our new coupe, which is very comfortable. 

The people are progressive and co-operative, and we also find the local 
physicians ready to help the work along. 

The report of visits to the end of December 28th is as follows : Seven 
to schools and ninety-four to homes for interviews relating to the organi- 
zation and in the interests of school and small children. There were 
twenty-five nursing visits, making a total of 126. 

We have only made a start as yet, but the work and district promises 
to be interesting, there being plenty of opportunities for carrying out a 
general public-health programme. The people are asking for classes, such 
as first aid, etc. We hope to have activities of this kind started in the 
near future. 

M. A. Twiddy, E.N. 



THE HOME SCHOOL VISIT, SAANICH. 

The duties of a School Nurse are almost innumerable. Unless there 
is an adequate number of nurses in any one district, some part of her work 
is necessarily neglected. 

The nurse must be present during the School Medical Officer's yearly 
examination of all the children. This is necessarv for several reasons. 

14 



Parents are more inclined to object to the procedure if a nurse is not in 
attendance. Again, the nurse cannot have a complete knowledge of the 
physical condition of each child unless she sees the examination. This 
takes up a great deal of time. 

Weighing and measuring, routine skin inspections, checking up 
infectious diseases by inspecting contacts daily and looking up absentees, 
making arrangements for those unable to pay for dental treatment, care 
of minor skin infections in the school, so that children may not lose 
unnecessary time for school, keeping adequate records; these and many 
others are the essential duties of a School Nurse. 

What time, then, is left for home school visiting? It is very easy to 
send home notices concerning defects which the school doctor's examina- 
tions have shown, but of what use is it to find hundreds of defects year 
after year and not have the greater proportion of these corrected ? Home 
school visiting is the only solution of this problem ; because the necessity 
of this is not as urgent as keeping the school free of infections, the home 
school visiting is put off from day to day in the hope that more time may 
be available later. 

Not one visit but two, three, or four may be necessary. Hope for 
correction of defects should not be given up as long as the child is at 
school, because sometimes the sixth or seventh visit will accomplish what 
has been apparently hopeless on former visits. 

There are many reasons why parents need individual attention from 
the nurse before results are encouraging. The stumbling-block is very 
often lack of funds. The nurse can usually make some arrangements for 
such cases if the parents are willing to co-operate, but home-visiting is the 
only way to accomplish this. 

Prejudice is perhaps the most difficult with which to deal. Here we 
not only have to wear down one set of ideas, but to build up others in their 
place. This is practically never successful on the first visit. In many 
cases faddists and quacks have reached the parents before the nurse. The 
problem is then increased tenfold. 

There is also the indifferent parent. Many times we have found that 
the mother has completely forgotten what defects the physician has dis- 
covered. In the face of such indifference one visit is hopelessly inade- 
quate. Often after two or three visits the objective is reached, and we 
feel that the time has been well spent. 

In some cases, if we can point out for what reasons a certain defect 
should be corrected, we are successful. For instance, if we can convince 
the mother that infected tonsils or decayed teeth are the causes of 
repeated attacks of cervical adenitis or that frequent sties are the result 
of eye-strain, we have no difficulty in persuading her to have these cor- 
rected. Whereas a notice to the effect that glasses are needed is ignored 
unless the child complains that he cannot see. 

The causes of malnutrition in a child can be discovered only by close 
questioning of the mother and investigation of the home conditions. 
Frequently one visit will correct all the trouble and a healthy, happy 
child is sufficient reward for the nurse's care. 

15 



During- the home school visits we can often persuade the parents of 
the necessity of having- their children immunized against smallpox and 
diphtheria, where a notice is absolutely ignored. Preventable infections 
are a blot on anv community and it is largely due to the efforts of the 
Public Health Nurse that immunization can he carried on. 

Home school visiting is so vitally important that it is better to 
neglect some other branch of the work if it is absolutely impossible to 
cover all the field. 

Esther Naden, K.N. 



THE COWICHAN DENTAL CLINIC. 

This short article is not to tell you the whys and wherefores of start- 
ing a dental clinic. It is merely to inform you how the Cowichan Dental 
Clinic is carried on and the need it fills in the district. Mrs. Moss, our 
President, was the originator and director of the scheme, which enabled 
Duncan and rural schools to have the services of the dentist at minimum 
charges. 

Our clinic is carried on within the school itself. Usually the teachers' 
rest-room is the most convenient place to set up our dental chair and 
table. Put in rural schools we are enthroned in the cloak-room amongst 
rubbers, gum boots, and coats; or, when the sun is shining, outside on 
the stoop. 

On our first visit to the school, Dr. French, the school dentist, ex- 
amines the children's teeth. The nurse fills out the cards, marking the 
defects, and the cost of the dental repair is added by the doctor himself. 
The dental cards are then explained to the children and sent home for the 
parent's signature. A week or so is allowed to elapse before the second 
visit in order that all the cards will have been returned. Then the actual 
work begins. 

The children are very interested in the dental work. It is very 
gratifying to the nurse to find her sometimes languid listeners so enthusi- 
astic and interested. The boys and girls themselves are very anxious to 
have their teeth attended to, but a few of the parents are not so co-opera- 
tive. It often requires two or three home school visits, plus plenty of 
common-sense reasoning, before the parents will comply. After the con- 
sent of the parents it is plain sailing. 

" Oh, for a stimulus to our health-teaching/' is often the cry of our 
School Nurse. One answer to this cry seems to lie in the visits of the 
dentist and the doctor. These two visits tend to arouse the children to 
greater heights of interest and attention to health habits. Such visits 
are a boon to the School Nurse, who is for ever striving for the formation 
of these health habits in the young life of the school. 

The large Duncan Consolidated School gathers its pupils on buses 
from a radius of 5 miles distant. Thus a very large area is under the 
services of our clinic. We, in the Cowichan Health Centre, are verv 
interested in this phase of the work and very anxious to improve, if pos- 

16 






sible, its administration. We would appreciate any helpful suggestions 
along this line. Since the clinic's re-establishment in the last year it lias 
proven to be of great use in the district and we think it is now firmly 
reinstated. 

A. Yates, R.N., 
Coivichan Health Centre. 



THE ORGANIZATION OF PUBLIC-HEALTH WOEK IN THE 
KELOWNA RURAL DISTRICTS. 

It is a most interesting, stimulating, and (may I add) somewhat 
alarming experience to be sent to develop all phases of public-health nurs- 
ing in a territory of some 100 square miles; to be given the opportunity 
to " sell " public-health nursing to small rural communities, who perhaps 
have never thought about the matter, or, if they have thought, consider 
" nursing " to mean bedside care of the sick, and preventive work in 
general rather a waste of time and very unnecessary ' But what a wonder- 
ful opportunity to till virgin soil and " make two blades of grass grow 
where none grew before!' And what satisfaction amid the stress and 
toil to see the work gradually develop under one's hand ! 

Kelowna rural districts consist of thirteen small farming communi- 
ties, scattered over an area of some 100 square miles, each with its school 
and Board of School Trustees, with a total school population of some 
GOO school-children. 

Six of the School Boards had expressed a desire to the Provincial 
Board of Health to have a School Nurse, and it was my duty also to visit 
all the other schools, and convince the ratepayers and School Boards of 
the value of the health service which could be rendered in their schools 
and in their community life in general. 

On reviewing the total situation and planning a programme, there 
appeared to be six main avenues of approach. It would be necessary to 
enlist the sympathy and co-operation of the local physicians, the teachers 
in the schools, the mothers in the homes, the local women's organizations, 
the Boards of School Trustees, and the ratepayers at large. 

The first step, therefore, was a personal call on each local physician, 
armed with a letter of introduction from the Provincial Board of Health. 
In this interview I endeavoured to explain just what I was planning to do, 
offered my services and co-operation, and asked for their sympathy and 
co-operation with the work. Here I had a most encouraging and kindly 
reception. This step is placed first because I feel that in any health 
scheme it is most important that the local physician should be in sympathy 
with the work, for they have the confidence of the public at large and have 
it in their power to greatly hinder or greatly assist the Health Nurse and 
Medical Officer of Health in their work. 

The next step was a call on the Inspector of Schools, which also met 
with a very kind reception. He very kindly gave me letters of introduc- 
tion to all the teachers, asking for their co-operation in the schools. These 
letters were invaluable; they gave the right note to the entry of the School 

17 



\ 



Nursing Service and secured the splendid co-operation of the teachers, 
without which the work is so much hindered and its effects neutralized. 

So far for the schools, but how was the infant's and pre-school child- 
welfare programme to be promoted? 

Most fortunately there were in four of my districts three local 
Women's Institutes and a Women's Club. A chat with some of the 
members and a letter to the secretary, asking for their help and interest, 
resulted in an invitation to speak on child-welfare work at the various 
monthly meetings. These opportunities were eagerly seized and the value 
of child-welfare work and clinics put before the members. Here I met 
with a most cordial reception and found the members much interested in 
the health service and willing to co-operate in the promotion of local well- 
baby and pre-school clinics. 1 have found that the Women's Institutes 
in any community are the most invaluable allies in the promotion of 
health-work in all its phases. It is often the institute which has sponsored 
the idea of a Health Nurse in the first place, and which holds out a 
welcoming and helpful hand to the nurse when she arrives. 

The next step, of enlisting the sympathy of the mothers, was carried 
out by home-visiting to infant, pre-school, and school children and to the 
expectant mother. In a few cases of severe illness a practical demonstra- 
tion of bedside nursing was given, but it is impossible in a large, widely 
scattered area, served by one nurse, to give a generalized nursing pro- 
gramme, because it interferes so much with the time that should be 
devoted to educative work in public health. Even so, the Health Nurse 
is often called in as a consultant in sickness and wins the confidence of 
the mother in this way, besides being invaluable to the local physician in 
the report which she is able to turn in to him. When visiting in the 
districts where the ratepayers in general did not want a School Nurse, 
I impressed upon the mothers that if they wished to keep the nursing 
service they must use their influence at the annual meetings of ratepayers. 
The results were quite good! 

The fifth and sixth steps of enlisting the sympathy of the School 
Boards and of the ratepayers at large were perhaps the most difficult 
of all. 

The school trustees are locally appointed and are guardians of the 
school finances, and also responsible for seeing that the provisions of the 
" School Health Act " are carried out in the schools. I have found that a 
personal visit when troubles crop up, or a round-table conference, explain- 
ing our methods and aims, and in which the advice and aid of the trustees 
is sought as health guardians, is an excellent way of obtaining co-opera- 
tion and help. 

A personal heart-to-heart talk will do more good than a dozen letters, 
and the trustees are quick to recognize the fact that the Health Nurse 
really cares for and is interested in the well-being of the children. 

We have partly solved the problem of working with thirteen different 
School Boards by the formation of a Kelowna District Schools Health 
Association, to which each School Board is asked to appoint a member. 
This was made possible by the enthusiasm and interest of a public-spirited 

IS 






citizen, Mr. E. O. MaCGinnis, who voluntarily acted as secretary-treasurer 
and spent muck time in organizing the association. To him Ave owe a 
great debt of thanks. 

The association deals with the partial financing of the School Nursing 
Service on a pro rata basis for each school-child, and also acts as an 
advisory committee to which the nurse can bring her problems and give 
reports. At present our executive is working on the problem of a school 
dental clinic, a difficult problem for many reasons, chiefly monetary. To 
enlist the sympathy of the public in general takes time and education. 
An invitation to speak at the ratepayers" meetings was gladly accepted, 
but the only way to convince a community of the value of the work is by 
the results obtained. 

I could not clpse a description of organizing public-health work in the 
Kelowna rural districts without a reference to the splendid co-operation 
of our full-time Medical Health Officer and School Medical Officer, Dr. G. 
A. Ootmar. To work hand in hand with a man of his wide experience in 
health-work is a privilege in itself, and without his appreciative co-opera- 
tion very little could have been accomplished. And last, but not least, 
are the understanding and inspiring letters from the Provincial Board of 
Health, which always seem to come just at the right moment and are a 
veritable source of inspiration and comfort. 

In spite of all criticism and difficulties, it is a joy to " carry on," for 
the field is so varied and interesting, the opportunities for service are 
countless, and there is great satisfaction in even a very partial demonstra- 
tion of what can be done for the good of a community by the installation 
of a Public Health Nursing Service. 

Anne P. Grindon, K.N. 



ESQUIMALT RURAL NURSING SERVICE. 

We all have our different views as to what a health centre should be 
and how one should be run, and in the hope that this will bring forth 
some discussion on the subject (probably at the Nurses' Annual Refresher 
Course), I would like to use the space allotted to me in the Bulletin this 
year as a means to broadcast my views as to what a health centre should 
mean, and be. 

In the first place, my ideal health centre should be exactly what its 
name implies; it should radiate health. There should be no suggestion 
of sickness in any shape or form attached to it. Its motto should be 
" prevention by education." It would be a real educational centre, where 
advice and information would be given, free, to people of all ages. 

The " care of the sick " would, of course, still be a very important 
part of the work, but the real work of the health centre would be " the 
care of the well to prevent them from becoming sick." 

This latter can only be accomplished through the medium of a well- 
organized health centre, with a well-trained, thoroughly experienced 
Public Health Nurse in charge, for it must be realized that a nurse with 
years of experience in the field has a strategic position for the detection 

19 



of mental and emotional difficulties, and through her daily experience 
learns to distinguish between modifiable and unmodifiable human material. 
There is so much that can be done along the lines of prevention — by 
education. 

My ideal health centre should have its consulting-room, and a " pro- 
fessional " room where children's teeth would be attended to regularly 
and where children of pre-school years could be brought by their mothers 
for regular examination and advice regarding proper feeding and the 
correction of am- defects. 

And the health centre could not be ideal without the services of a 
Medical Health Officer who would make every public-health problem a 
matter for public-health education, and public-health education a per- 
sonal education for the people who contribute the funds. 

" Three score years and ten " has been for generations the accepted 
term of the life of man. If one happens to live longer than that, as they 
occasionally do, he is made much of. The newspapers take the matter 
up and he is interviewed and asked to what he attributes his unusual 
longevity. And the reasons given all vary ; as a matter of fact, they 
don't know themselves — they are just healthy. 

The average term of the life of man, as statistics prove, is far short 
of the accepted three score years and ten. But the Bible says : " And his 
days shall be an hundred and twenty years." Then let us strive to give 
man his biblical quota, and let him have a century of life at least. And 
while we try to add years to his life, let us be sure to add life to his years 
and make them hale and vigorous. 

Through my ideal health centre we should learn to live health, talk 
health, think health; publish health news in the right way, through the 
nurse, through the press, b}- the motion picture, the radio, slogan, and 
poster, or in any other way. We would teach it. Teach hygiene and 
have our centre a shining example. Teach the value of play and make the 
centre an example. Teach the value of happiness and the joy of helping 
to make others happy and make the health centre again an example. 
Teach the effect of smiles upon the health, and warn against anger and 
worry, and not onlv warn against, but do our best to alleviate the worry 
that most probably causes the anger. We would make the centre a place 
where people love to come, where they can bring their worries and get 
them off their chests; where children love to congregate, and where they 
may learn truths about themselves and life, and how to care for their 
precious bodies so that they may grow up to be healthy men and women. 
It is only by education in the matters of health that we shall be able to 
cut down the cost of the upkeep of our sanatorium^, hospitals, homes for 
the incurable, and mental hospitals, etc. 

Through my health centre we should keep the people up to the times 
in regard to health teachings, by supplying health literature, holding- 
meetings, giving health talks, organizing health pageants, teaching hygiene, 
health exercises, etc. Science may outstrip public knowledge, but hygiene 
remains to serve the people. 

Some of these things I have mentioned I am able to do, but not nearly 
enough. Funds available do not allow a great deal of margin for improve- 

20 



ments'i However, some day I hope to see my dream realized. In my 
district we do a good deal of educational work and I am strongly backed 
bv the Women's Institutes and the Boards of School Trustees. Also 
I have a progressive committee and am confident of their help and support 
in any reasonable move. We shall continue to work with and for our 
public until public opinion is strong enough to back all practical, con- 
structive health-building plans. 

Helen Kelly, R.N., 

Nurse in Charge. 



VERNON. 



About seven years ago the Women's Institute got behind a movement 
here to secure a District Nurse for the Vernon District. With the assis- 
tance of Dr. Young, a very able and experienced nurse was sent. Miss 
Payne came highly recommended and proved to be a very courageous and 
tireless worker. In a short time she had babv clinics and Little Mothers' 
League classes established and was giving health lectures whenever and 
wherever possible. She worked largely with the Women's Institute and 
visited outside districts under the auspices of the Women's Institutes. 
Miss Pavne worked in this district for two years and when she left health 
nursing was well established. 

Miss Dunbar was then engaged by the Board of School Trustees as 
School Nurse. Miss Dunbar did part of the district as well. At the end 
of the school-year her health failed and she was obliged to resign in 
June, 1924. 

No attempt was made to get another nurse until the end of the fall 
term. The people had been insistent in their demand for another nurse 
in the schools. I was engaged as School Nurse in January, 1925, and have 
held that position up to the present time. Thanks to the excellent founda- 
tion established here by the nurses before me, I have had the best of 
co-operation between the school staff, School Board, and the parents. 

A dental clinic was formed two years ago and is in operation. We 
hope to see a travelling dental clinic, or something similar, for the whole 
of the Okanagan Valley in the near future. 

Baby clinics are held under the auspices of the Women's Institutes, 
and I also take charge of any baby clinics held at the Vernon Jubilee 
Hospital. 

Home-nursing classes have been carried on for the past four years, 
at first with the adults as well, but now with the high-school girls only. 
This year we have two half-hour classes each week. 

The School Nurse is also responsible for the teaching of health to all 
the grades in the public schools. The new text-books on health physiology 
and hygiene authorized for use in the public schools are excellent; the 
language is simple and the subjects are presented in a very interesting 
way. I have found the following additional books very useful : " The 
Land of Health," by Hallock and Winslow (published by Chas. E. Merrell 
Co., New York and Chicago), good for Grades TIL, IV., and V.; ''The 
Most Wonderful House in the World," by Haviland (published by J. B. 

21 



Lippincott Co., London and Chicago) ; " Good Neighbors," by Haviland 
(published by J. B. Lippincott Co.) ; " Healthy Living," Books I. and II., 
by Winslow (published by Chas. E. Merrell Co., Chicago). These books 
have been a great help to me this year in teaching health to the lower 
grades. 

Junior Red Cross groups have been organized for the past four years 
in Vernon schools. One of the best meetings that I have ever attended 
was held by one of the Junior Red Cross groups this month and was con- 
ducted by the children themselves. 

On the whole, health-work in Vernon is progressing. We need a 
District Nurse and the Women's Institute hopes to be able to secure one 
for Vernon and surrounding districts this year. 

I am indebted to the Provincial Board of Health for valuable assis- 
tance and encouragement in my work here. 

E. Martin, R.N. 

Vernon. 



i & v 



PUBLIC HEALTH IN NANAIMO. 

The aim of all public-health nursing is education in obtaining and 
maintaining health. This past year there has been more emphasis on that 
most absorbing branch of public-health work- — namely, child and infant 
welfare. 

A list of the births in the district is now obtained monthly from the 
District Registrar and, general duties permitting, the first visit is made 
before the infant is a month old. So far there has been not only a hearty 
welcome for the nurse on her initial visit, but a cordial invitation to 
return. The advantages of the well-baby clinic are explained to the 
mother, who is urged to attend. If unable to do so, a monthly visit to the 
home keeps the nurse in touch with the progress of the infant. Getting 
the names of all babies from the Vital Statistics Department means con- 
tact with a greater number of mothers in their homes, the effect of which 
is showing in the increased number being enrolled in the well-baby clinic. 
Because it is through the clinic that the defects which are beginning 
are pointed out to the mother, advice is given, and then they are urged 
to consult their family physician for correction of these defects, it is 
important to maintain in many instances a newly aroused but keen 
interest. 

Last fall, when the Indians returned from the hop-fields, a well-baby 
clinic was established at the Indian Mission. The mothers are very 
enthusiastic and strive earnestlv to carry out the nurse's instructions. 
Beginning January, 1929, the entire reservation was placed under super- 
vision of the nurse. The school now has routine inspection; the sanita- 
tion and general hygiene of the homes is being investigated ; food problems 
everywhere to be solved; the pre-school child observed and the prenatal 
patient advised; and so with the application of these preventive measures 
the Indian tuberculosis menace is being attacked at the roots. 

A. Verna Beckley, R.N. 

22 



THE VALUE OF TEE-SCHOOL WORK. 

In discussing welfare-work, one is prone to speak of infant-welfare 
work only. Many people think that when a child has reached the second or 
third year of life safely all the early dangers are past. They think, also, 
that if the mother has all the available help and information necessary 
for the weaning and the teething periods she will be quite capable of 
bringing the child to school age without mishap. 

Let us look first at the home conditions of the pre-school child — the 
child between the ages of 2 and 6 years. Up to 2 years of age the child 
has been the most important individual in the household. If there is a. 
Public Health Service in the district, the Public Health Nurse has visited 
it frequently. Its diet and habits have been regulated. Arriving at the 
age of 2, it is apparently a healthy, happy, normal child. In all proba- 
bility a baby brother or sister makes its appearance about this time. 
The centre of interest promptly shifts. The nurse visits as formerly, 
concentrating now on the new infant. She ma} T inquire about the health 
of the runabout and give him a cursory glance. Little intensive health- 
work is done on his behalf. The mother, unless some definite ailment is 
apparent, feeds him a general diet, clothes him, and puts him out to play. 

The preschool child of to-day is the school-child of to-morrow. A very 
large proportion of the beginners in a school are hampered by preventable, 
removable, or curable physical defects. These are defects which should 
have been observed and remedied during the pre-school years. Many of 
the dental troubles, tonsil and adenoid involvements, faulty eyesight, 
malnutrition, and other defects are due to incorrect health and dietary 
habits. Proper care in the pre-school years may greatly reduce not only 
the percentage of these defects, but also much of the permanent harm 
which may be done. 

There are two main reasons why this preventive work should take 
place in the pre-school years: First, the cost; secondly, the permanent 
harm that may be done. The latter may also be reduced to dollars and 
cents. It is through the medium of the " last " that the general public 
may be most easily approached. 

A child entering a school with a remedial defect is a constant source 
of expense. If it be a dental defect, time may be lost due to toothache, 
time for repair- work, or time and expense due to future complications. 
If it be a tonsil defect, loss may be due to general ill-health or repeated 
colds and tonsillitis. Jf visionary or auditory defects are present, loss of 
time may be only due to general retardation. Thus the teacher's time is 
wasted and the progress of the entire class is retarded by irregular atten- 
dance. The School Nurse and the School Medical Officer examine the 
child and discover the defect or defects. The nurse does all in her power 
to have the defects corrected. It does not mean as a rule one home school 
visit, but many home school visits and more time expended. Time is 
money. 

The other reason for the removal of defects during the preschool 
years is that much permanent harm may be done to the individual. Faulty 
eyesight which is neglected may become so aggravated that it will in later 

23 



years prohibit the individual from earning a livelihood — again a source 
of expense to the relatives or to the community. There are many defects 
which can be remedied easily or without surgical measures in the early 
years. Strabismus is a very important example of this. 

A large proportion of the free patients in the public wards of the 
city hospitals are suffering from chronic heart or rheumatic conditions 
due to tonsil infections. Many of these could have been prevented in 
early childhood. They are now a community expense. 

In order that the loss of time — pupils', teachers', and School Nurses' — 
and that the expense of the indigent patient may be avoided, let the pre- 
school-welfare work be as intensive as the infant-welfare work. It is not 
necessary that the pre-school child be seen every month. However, one 
visit will not be sufficient to convince the parent of the necessity for 
correction of defects. It is only the constant pressure of repeated visits 
that will bring results. Pre-school clinics with a capable physician in 
charge are invaluable. In a rural community these may be managed in 
conjunction with the infant-welfare clinics. Yearly or bi-yearly visits 
would be sufficient in the case of the normal pre-school child. Intensive 
follow-up work or repeated visits are necessary when defects are found 

or general care is unsatisfactory- ^ -r T -r. -vt 

& J Nora IIiggs, R.N., 

Saanich. 



HEALTH-WORK IN PORT ALBERNI. 

As it has frequently been said, it is difficult to measure progress in 
public-health nursing. Perhaps a good gauge is the awakening of the 
interest of more individuals in the community, not only of those who have 
been helped in time of illness, but also of those who are in a position to 
guide the affairs of the district. 

An encouraging milestone along the way of the health-work here is 
the well-baby clinic, starting this coming month, as soon as Meads' baby- 
scales arrive from Ontario. The clinics will be held in the lodge-rooms 
of the Order of the Moose twice monthly. The use of these convenient 
and comfortable rooms has been granted for a very small sum for each 
meeting. 

From the interest shown by the mothers while discussing these clinics 
with them, we are looking forward to many opportunities to aid in the 
promotion of the health and in the development of at least some of the 
coining generation. As elsewhere, it is astonishing to note the number 
who do not realize the importance of breast-feeding, regular and proper 
feeding of infants, until it is carefully explained to them. 

I think the infant-hygiene branch of the work is the most encouraging, 
as most of the mothers are keen for advice where the welfare of their 
babies is concerned. 

It is gratifying to hear on some visits, " My neighbour told me to 

give the baby 'potatoes and gravy,' but I wouldn't until I asked you"; 

or, again, " I thought I should wean the baby, but I waited until I saw 

you." Such instances as these help one through a day that has its own 

problems. : 

24 



The school-work is an accepted fact by an increasing number of 
parents. This is shown by advice asked for and co-operation given in 
regard to correction of defects and to the attention to the diet of their 
children. 

Anti-goitre tablets have been given to Grades I. and II. twice weekly 
as a preventive measure. As they have only been given since last spring, 
it is too soon to quote their value in lessening of simple goitres. In giving 
them, opportunities are frequent for detecting infection and impressing 
the value of good health habits. The tablets are given in a series twice 
.yearly as treatment to all pupils having enlargement of the thyroid. In 
most cases there is a marked improvement. 

The Parent-Teachers' Association manifested its interest and co- 
operation by donating a large doll and other equipment for Little Mothers' 
League classes for Grade VIII. The layette was made by the pupils 
themselves. I do not think too much stress can be laid on the teaching 
of the essentials of infant-care in the impressionable early 'teens. Too 
often other interests take up all their attention after they leave school 
until long after the knowledge is required. 

Intelligent interest has been shown by home-nursing classes, also 
by a first-aid class of a C.G.I.T. group. In this, as in all branches of the 
service, a great deal of credit for the progress made is due to the com- 
mittee and a few more unselfish workers here. 

While I realize there is much — very much — still to be done, I am 
hopeful of further progress in the future. 

Mary E. Grierson, K.N. 



LADYSMITH. 






My short stay in Ladysniith has not seen anything very spectacular 
in the work. Public Health Nurses have to be satisfied with constant 
trifles in the way of effort and improvement. We alternately become cast 
down and encouraged, and in order to be happy in the work must be 
content to balance one with the other. 

Ladysniith is just now passing through a time of depression. Any- 
thing new and causing expense cannot very well be suggested. We 
sincerely hope that the worst is over and that the city has a great future 
ahead of her. 

The chief efforts of these months have been in connection with the 
dental clinic. Preliminary visits enabled me to make many contacts in 
the homes and served to interest the parents in the work of the clinic and 
their children's teeth in particular. Our dentist, Dr. Verchere, has been 
able to accomplish a great deal of good work since he started in January 
and there is much more to be done. The School Board has now a dental 
chair and the greater part of the work is done in the nurse's room. This 
makes it easier to deal with the bigger children, as getting them to the 
dental rooms is quite a problem nowadays. If the greater percentage of 
the children could be treated one year, quite a small amount of work 
would be necessary for the succeeding years. With the help of the Gov- 



eminent grant, the fee that has been charged is about half-price. Unfor- 
tunately some of the parents cannot afford even this. 

In this district we have a large percentage of foreigners, especially 
Finns. Visiting these people, I have been very much impressed with the 
beautiful cleanliness of the homes as well as the kindly welcome offered 
to the School Nurse. It is encouraging to hear that the health-teachings 
are carried home to the parents. These young Canadians understand the 
speech of their parents quite well, but as a rule answer in English. What 
a pity it is that some of them consider the language of their parents some- 
thing to be ashamed of! 

The health-teaching has proved very interesting and handkerchief 
drill with the first two grades most amusing. The teachers show great 
interest and have been most anxious to help. 

With the co-operation of the art teacher — Miss Tranfield — we held a 
competition in health posters. The four upper grades did these as part of 
the school-work, and some very fine ones were completed and are now in 
the nurse's room, where they make quite a good show. A prize was given 
for boys and one for girls. The principal kindly lent his aid in the judg- 
ing. So many fine ones were shown that we felt sorry there were no 
second prizes. 

We were fortunate in having a visit from Dr. Lamb in January, when 
several patients and six school-children who Avere contacts were examined. 
The six contacts were all found to be free of disease, much to our joy. 

We have started a branch of the Junior Red Cross and find it very 
interesting. The children enjoy the magazine very much. At present 
they are making scrap-books and preparing a portfolio to exchange with 
one from Durban. As this takes up a good deal of time, one of the 
teachers has agreed to help with this work. 

The Little Mothers' League has been very interesting too. An older 
class of girls would be more suitable for a real mother-craft course, but 
the C.G.I.T. seems to be enough for them. 

The lack of transportation has meant the curtailing of a great deal 
of the country work, but great kindness has been shown by the teachers 
with cars and many others on the roads. 

At South Oyster the parents are very wide awake and much interested 
in all the health-teaching. It is reflected in the condition of the children 
who attend the small one-roomed school. 

H. Peters, R.N. 






SCHOOL NURSING IN KELOWNA CITY SCHOOLS. 

Kelowna is for many reasons a charming place in which to live and 
work. It is beautiful and has a pleasant climate and delightful people. 
The population is about 4,500 and most people are connected with some 
branch of the fruit industry. 

I arrived in Kelowna not long before the great annual event, the fall 
fair. Mrs. Grindon, Public Health Nurse in the rural districts of 
Kelowna, and myself were asked to put on a health exhibit at the fair. 

26 



After due consideration we decided to stress two things : First, immuniza- 
tion against diphtheria by the use of toxoid; secondly, the need of a 
school dental clinic. In the spring of 1928, during a diphtheria epidemic, 
much valuable work was done by Mrs. Grindon and Dr. Ootmar, Medical 
Health Officer for the rural districts. Many children were Schick-tested 
and a number were immunized. It therefore seemed a golden opportunity 
to strike while the iron was hot and to place the idea of immunization be- 
fore the public. Even the short time which I had then spent in the schools 
had been sufficient to show me the crying need for dental care. Mrs. 
Grindon's findings in the rural schools showed the same thing. We there- 
fore seized the opportunity to stress this need also. In putting on the 
exhibit we were aided financially by the local and rural Women's Insti- 
tutes and by the Kelowna school trustees. Local merchants were very 
generous in loaning us any articles we needed. For the immunization 
exhibit we had two model school-houses. One was closed due to diph- 
theria; the other open, with perfect attendance, because the pupils had 
been Schick-tested and immunized. Kewpie dolls were dressed to rep- 
resent pupils and School Nurse. These, of course, attracted the attention 
of the children tremendously. Posters and literature further explained 
the idea. The dental exhibit consisted of a display of toothbrushes, food 
to build teeth, and a perfect set of teeth. This also was supplemented by 
posters and literature. In dressing the dolls and making the posters we 
had wonderful assistance from interested friends. Some of the posters 
were done by the school-children. The fair lasted for a day and a half, 
during which time either Mrs. Grindon or myself were with the exhibit 
ready to answer the numerous and varied questions of the public. The fair 
was opened by His Honour the Lieutenant-Governor and Miss Mackenzie. 
We were much gratified by the interest which they took in the health 
exhibit and by the many questions asked by Miss Mackenzie. About 
1,200 pieces of literature were distributed. This came mostly from the 
Metropolitan Insurance Company. We feel that the time spent on the 
exhibit was time well spent, because it brought public-health work and 
some of its aims prominently to the notice of the general public. 

My work in Kelowna up to the present time has consisted largely of 
school-work. Kelowna has five school buildings — the High School, the 
Manual Training building, and three Public School buildings. They are 
somewhat scattered, but are all within easy walking distance of each other. 
In these schools almost 1,000 children are being educated. This year 
there has been considerable crowding in the Public School and plans are 
already on foot for another new building. My office is in the newest and 
smallest of the Public School buildings. Here I keep my supplies and 
"records. I have definite office-honrs each day, when the children come to 
me for minor treatments and for permits to return to school after two or 
more davs' absence. 

The medical examination of the pupils by the school doctor was done 
this year immediately school opened. Since then it has been my aim to 
inspect every pupil once a month. These inspections have revealed the 
usual appalling" number of dental defects and have made it very evident 



'41 



•that the solving of the dental problem is an urgent matter here. Quite 
a number of children with infected tonsils have been operated on during 
the past few months and many children are being treated for goitre. 
Systematic weighing of the children has been difficult this year, due to 
the lack of proper school scales. However, I am happy to be able to say 
that these have just now arrived. Underweight children have been 
encouraged to take pure cod-liver oil and have been supplied with sample 
bottles which one of the local drug-stores very kindly provided. 

Every Monday morning I get from each teacher a list of absentees. 
Looking up absentees provides a good entrance to the home and can be 
combined with much good public-health work. I also make many other 
visits and the appreciative attitude of the parents makes these a pleasure. 
It takes a long time to make a few visits, as Kelowna is somewhat scat- 
tered and I have to walk everywhere I go. Accounting for every absentee, 
and seeing that each one has a permit from either a doctor or myself 
before returning to school, forms a fairly adequate check upon infectious 
diseases. Mumps has been most persistent this winter, but at the same 
time the number of cases has not been alarming. Contacts have been 
saved much loss of time by being allowed to come to school during the 
non-infectious period of incubation, and then excluded for a definite time 
according to the Government regulations. This method would not be 
possible without close supervision. Whooping-cough has been kept in 
check, children with suspicious coughs being excluded until a definite 
diagnosis could be made. We are at the present time doing our utmost 
to prevent the spread of measles. 

The educational side of my work occupies a good deal of time, as 
there are twenty classes in the Public School and every class receives a 
health talk once a week. The High School unfortunately can find no time 
for health-work. I take up a definite subject with each class every month 
and try to present it from various angles. I use the story- telling method 
in the lower grades, and some of the teachers have shown splendid co- 
operation in the making of posters and health-books. The distribution 
of literature is a help in all the grades. The results of health-teaching 
are especially gratifying among the younger children, who are still at the 
habit-forming age. Person ally, I often feel very much at a loss as to how 
to teach health, and I would give a great deal to have some more definite 
knowledge of teaching methods. I feel that teaching is an important part 
of our work for which we are ill-prepared. One thing which is a great 
help to me is the health magazine Hygeict/. It is full of practical knowledge 
and helpful ideas. The descriptions of the health projects worked out in 
the schools of Newton, Massachusetts, are a source of inspiration. 

My first Little Mothers' League class is now almost over. The mem- 
bers have been keen and enthusiastic. Many other " little mothers " are 
now anxious to take the course. 

This year Junior Red Cross has been organized in Kelowna Public 
School. Very fortunately Miss Hodge, Director of Junior Eed Cross, 
visited Kelowna soon after the opening of school. She gave an inspiring 
talk in every room in the school and aroused the interest of the children. 
Many of the classes have formed branches. 

28 



The platoon system, which we have in the upper grades here, makes 
it difficult to hold meetings, as the pupils have comparatively little time 
in their own room and with their own teacher. In December the members 
sold f 10 worth of the tuberculosis seals. At the Christmas concert some 
of the sixth grade children put on a health play, which went over very well. 
In one of the primary grades the children are using their Red Cross money 
to buy a mid-morning drink of milk for a little T.B. suspect in their room. 
It is a pleasure to watch the improvement in this little person. I find the 
Junior Red Cross in every way a help to public-health work. 

Early last fall Dr. Scott-Moncrieff, ear, eye, nose, and throat specialist 
from Victoria, held a clinic here. Two school-children and several pre- 
school children attended the clinic. Later we had the advantage of Dr. 
Lamb's chest clinic. I referred eight children to this clinic. Of these, 
two proved to be suspects. One boy is remaining away from school until 
Dr. Lamb comes again. This child is showing marked improvement. 

Plans are now under way for starting a baby clinic in Kelowna with 
the help and co-operation of the Women's Institute. 

Six months of work in Kelowna now lies behind me. Whatever has 
been accomplished is due to the kindness, sympathy, and co-operation 
which I have received from the school trustees, teachers, doctors, and 
parents. Dr. Knox, Medical Health Officer for Kelowna, has been a never- 
failing source of help and encouragement. 

Last, but not least, come letters from the Provincial Board of Health, 
always full of hope and cheer, and always bringing to the fore the great 
aims for which we are all working, but which, so easily, become lost in 
the petty vexations of every-day life. 

Frances Lyne, R.N. 



PUBLIC-HEALTH WORK IN KAMLOOPS. 

The subject of public health is an ever-increasing study and interest. 
One wonders sometimes how much the average public knows about this 
subject. Certainly of late years it has been given a great deal more 
publicity. There is still much needed. Those interested in this work 
have a wonderful scope and every opportunity should be taken to educate 
the public mind. This can be done in many ways — articles, public-health 
lectures, and also in our schools. 

The children will take home and present to their parents more than 
any Public Health Nurse would dare. We should teach these children 
the real meaning of hygiene and prevention of disease and the great value 
of health. Children love anatomy and hygiene. Naturally they have been 
curious heretofore to understand many problems. It is their right to 
treat them as intelligent beings and to give them the credit of reason- 
ing powers. It is just wonderful to watch and try to understand the 
psychology of the child's mind. They are so ready and willing to absorb. 
One might liken their unfolding to that of a flower. How full of wonder 

29 



and trust ! How vastly important, then, is the matter of teaching. It 
certainly makes us feel we must present the truth in a clear and under- 
standing manner, always giving the best Ave can offer, always creating 
an atmosphere of definite and positive thinking. 

The Junior Red Cross Society here has a wonderful opportunity. 
I am delighted to say that I have organized five groups in one of our 
schools — Grades II., III., IV., V., and also the girls of Grades VI., VII., 
and VIII. They are all very keenly interested. It is a great aid to our 
health-work. We have health competitions, health plays, musical appre- 
ciation afternoons, etc. The older girls meet once a Aveek. At present 
they are making their caps and aprons, Avhich they will wear later at all 
of their meetings. We have our business meeting monthly. It is just 
Avonderful the dignity with which these meetings are conducted. We are 
most fortunate in haA r ing Miss Lawrence, a teacher avIio gives much time 
to teaching them the pros and cons and the art of committee meetings; 
also Miss Stocks, avIio helps us with the seAving. I am giving the girls 
Little Mother League talks. Later Ave intend working for a bazaar and 
will join forces from the five groups. We hope to hold it about the end 
of May in the Lloyd George School. All the proceeds will be devoted 
towards paying for a baby Ave have sent to the Queen Alexandra Solarium 
from Kamloops. 

We AA'ere all delighted to have a visit from Miss Meta Hodge last 
autumn. She gaA'e many interesting talks to the children and certainly 
left a Avonderful impression. 

The usual routine school-Avork is done, including hygiene lessons 
given Aveekly to Grades VII. and VIII. of the Lloyd George School. A 
course of these lessons Avas also given to First-year High School before 
Christmas. By these means one feels that one is really getting in touch 
Avith the child, who is the real missionary of health. They in their turn 
take it into their homes. So through the mouths of babes, as it Avere, Ave 
will teach the parents. We also train the young mind to think in a 
positive and definite direction. The more positive our attitude of mind 
towards health the happier and healthier Ave must be. I gave a course of 
public-health lectures to the parents. 

The well-baby clinic is always a joy to attend. We have many young, 
interested mothers who bring their beautiful babies to us regularly for 
advice. Last year Ave held tAventy-one clinics, Avith an aA T erage attendance 
of 15.25 at each clinic. I made many home visits to these mothers. It is 
the kindness of the Red Cross Society that makes these Avell-baby clinics 
possible. We are now delighted to report a neAV step forward. This year 
Ave have organized a prenatal clinic. This will be held tAvice a month. 
Expectant mothers will be given private intervieAvs. General hygiene 
advice will be given, including the teaching of the handling, bathing, and 
making a cot for baby; urine will be tested and the mother advised to 
engage her medical doctor. We have already had a very nice baby's 
basket crib given us by a grateful mother. So Ave hope to get more in 
touch Avith the young expectant mother avIio needs so much teaching. 
As Sir -Triiby King said in his address to the Canadian Club in Van- 
couver last July, "The country's greatest asset is the mother; the 



country's best immigrant is the baby." It was indeed a great privilege 
to hear his most soul-inspiring address. Quoting him further : " A great 
deal is said these days of forest-protection from fire, etc., and rightly so. 
How much more, then, should we value the lives of our mothers and 
babies, and these children who so soon will be the citizens of the world." 

Olive M. Garrood, R.N. 



PUBLIC-HEALTH NURSING IN KEREMEOS. 

Keremeos, from the public-health standpoint, has passed through a 
quiet and rather uneventful year. Except for our old friend, the " Com- 
mon Cold," who behaved very badly during the month of January, a 
number of flu cases of a fairly mild character, and a pneumonia or two, 
there have been no infectious diseases for almost two years now. A case 
of infantile paralysis in a town about 48 miles away gave us a most 
uncomfortable feeling for a few days. Also a case of mumps, who refused 
to take himself seriouslv, nearly caused trouble until he was frightened 
into submission with the aid of the policeman. 

This district is particularly fortunate in its Medical Officer of Health. 
Not only is he a splendid surgeon and physician, but a keen public-health 
man as well. During last May and June almost every child in the district 
underwent a careful and very thorough examination at his hands. With 
the aid of the Women's Institute, three clinics were held in Keremeos 
and one in Cawston, each clinic taking children of a different age. 

The doctor was tremendously impressed with the babies, about his 
only criticism being that most of them were overweight. The pre-school 
children were also found to be above the average. In fact, taking the 
children as a whole, they are remarkably healthy. 

We have always looked forward so keenlv to a visit from Dr. Lamb, 
but look how I would, I couldn't find a single excuse amongst the school- 
children for asking him to come here. There are underweights, but with 
one or two exceptions all these make a steady gain. I have followed the 
plan learned in the Vancouver schools and do not count a child under- 
weight unless it is 10 per cent, below average. According to this scale, 
I have only 16 per cent, underweight. 

In the fall we made a raid on some of the tonsils, getting rid of many 
old offenders. It was not deemed advisable to hold a clinic in an ordinary 
dwelling, so I took the children two by two in my own little car up to 
Hedley Hospital, bringing them back the same day. This certainly took 
time, but the beautiful clean fhroats which have resulted from having this 
operation performed where there was better lighting and a suction 
apparatus more than justified the extra time and trouble. 

About 33 per cent. ,of the children have a slight enlargement of the 
thyroid Mand, but thpre isn't a single pupil in the schools showing- 
symptoms of a toxic goitre. The continuous use of iodized salts seems 
to be a great factor in its prevention. 

31 



Teeth, on the whole, are good and the children and parents interested 
in keeping them in good repair. We have an excellent dentist in town 
and it is with great satisfaction that I look at his work each month. 
This month I took real pleasure in marking 43 per cent, of the pupils 
" O.K." for permanent teeth; a few of these children still need some work 
on temporary teeth, but a great many more will have " O.K." for teeth 
before the summer holidays. 

In writing m} r small contribution to the Bulletin, I am just a little 
puzzled as to whether the article is from the nurse or from the district, 
so before closing I would like to say one little word for myself. I am 
leaving the service soon, but before I go I'd like to put in a special prayer 
for a supervisor. Not a person who would look too closely at my bag; 
it is never very tidy and full of all sorts of odds and ends; nor one who 
would frown upon my winter " uniform," but some one who would come 
along once in a while and help me growl or gloat, as the case might be. 
We lone nurses in the far-off districts do so desperately need some one to 
talk " shop " to occasionally. 

Kathleen Snowden, R.N. 



CO-OrERATION. 



It has been proved that co-operation is the greatest factor in the 
success of any public-health undertaking. Especially is it so in the 
control of communicable disease. There must be co-operation of teacher, 
nurse, parent, and doctor. There must be a public-health conscience 
developed in all responsible persons. The parent who sends a child to 
school knowing he is developing a communicable disease, for the purpose 
of finding whether it will be detected or not, is sadly in need of the 
development of such a conscience. 

We have in this district a marked example of the lack of a public- 
health conscience. Since June, 1928, we have been having an epidemic 
of one of the so-called diseases of childhood— mumps. It is still thriving 
and will continue to do so until every person who can have the disease 
has had it. Why? There are many reasons. One is peox>le believe it 
is such a slight thing that it is just as well to have it and get it over. 
We have been shown during the last two or three months that this 
trifling disease can cause most disastrous after-effects. Also cases and 
contacts excluded from school are allowed unlimited freedom. It is no 
uncommon occurrence to be sitting in the darkened theatre and find when 
the lights are turned up that one's neighbour on the right has a swollen 
neck. Again many cases have been diagnosed as " swollen glands," but, 
curious as it may seem, contacts have developed " swollen glands " on the 
eighteenth and nineteenth day. 

What a pity it is that having one disease does not protect one from 
all others. 

Norah E. Armstrong, K.N., 

Nanaimo. 
32 







TUBERCULOSIS-WORK IN BRITISH COLUMBIA. 

It is difficult to know where to begin an article of this kind, but it 
seems to me in order to first give a short explanation or history of the 
three chief agencies at work: First, the Provincial Travelling Health 
Officer; second, the Tranquille Tuberculosis Society; third, the Christ- 
mas seal. 

The Provincial Travelling Health Officer.— -In 1923 Dr. A. S. Lamb, 
who is a tuberculosis specialist, was appointed Provincial Travelling 
Health Officer by the Provincial Government to travel over British 
Columbia, holding consultations or clinics with the doctors and assist 
them in diagnosing and arranging for treatment of tuberculosis patients. 
This work he is still doing. 

The Tranquille Tuberculosis Society. — Some little time before 1923 
this society was formed by a group of ex-Tranquille Sanatorium patients. 
At that time their efforts were chiefly the welfare of the Sanatorium 
patients. They took over The TranquUlian, a paper then being published 
at the Sanatorium, and funds were raised mainly through subscriptions 
and advertisements. This money was spent in various ways, possibly the 
greatest single expenditure being the installation of an excellent radio 
with head-phones to each bed in the Sanatorium. 

The Board of Directors are a group who are intensely interested in 
the tuberculosis problem from the patients' welfare point of view as well 
as that of public health, and felt the growing need of discharged Sana- 
torium patients and their families keeping in touch with a tuberculosis 
specialist, as well as the need of finding new cases of tuberculosis in as 
early a state as possible. In order to raise additional funds for this 
extra work they undertook to sell the Christmas seal. 

The Christmas Seal. — The Christinas seal originated in Denmark. 
A postal clerk, Einar Holboell, was engaged in sorting Christmas mail. 
Each letter and parcel bore a Government stamp; the stamp cost but 
little and the purchaser was willing to pay to have his messages carried 
through the mail. It occurred to Einar Holboell that each letter and 
package might carry another stamp which would be sold for the benefit 
of a hospital for tuberculosis children. When the next Christinas came, 
the Danish mail was helping to start a health message which from that 
time has travelled through all the post-offices in the land at Christmas- 
time. 

In 1907 the story of the Danish seal was written up in The Outlook 
and was adopted in America for the first time to raise funds for tubercu- 
losis-work. The next year the American Red Cross carried on the enter- 
prise on a nation-wide basis and in 1910 made arrangements with the 
National Tuberculosis Association to manage the sale. Until 1919 these 
two organizations worked together. The Red Cross then withdrew and 
the National Tuberculosis Association, with the help of its affiliated State 
and local associations, carried on the sale, and the seal has borne the 
official emblem of the association, the double-barred cross. 

The Canadian Tuberculosis Association procures its seals from the 
National Tuberculosis Association, and in turn each local society procures 

33 



theirs from the Canadian Tuberculosis Association, returning a certain 
percentage of the money obtained to pay for the seals, etc. ; the rest of 
the proceeds go to carrying on tuberculosis-work in their own Province 
or locality. 

In the fall of 1928 the Tranquille Tuberculosis Society decided to use 
the funds obtained from the sale of the Christmas seals in providing a 
portable X-ray and a nurse to travel with Dr. Lamb and assist him in 
his work. Accordingly, in October, 1928, a nurse was put in the field, 
and in January of this year a portable X-ray was purchased. 

Dr. Lamb and his work vou are all familiar with. The X-ray is a 
wonderful help in clearing up the diagnosis in obscure and early cases 
of tuberculosis. The work of the nurse is more difficult to explain. Her 
aim is to : — 

Keep in touch with the patients at Tranquille and with their families 
at home. 

To assist Dr. Lamb at his clinics, take the X-rays, and do the records. 

To arrange for the examination of contacts and suspects at regular 
intervals. 

To help arrange for treatment at the Sanatorium, or at home when 
necessary. 

To get in touch with Public Health Nurses and solicit their aid in 
finding cases of tuberculosis and looking after them when diagnosed. 

To arrange for the necessary supplies, such as sputum-boxes and 
refills to be given to patients who remain at home or are discharged from 
the Sanatorium. 

Notices are sent to all doctors and Public Health Nurses advising 
them of the date the. next clinic will be held in their locality. If you have 
cases you would like Dr. Lamb to examine, he would prefer to have the 
family doctor notified and his consent obtained. However, if there is no 
family physician and the patient is in such circumstances as to be unable 
to afford one, they may be sent in without. 

It is the wish of this travelling tuberculosis clinic to co-operate with 
and have the co-operation of all the doctors and nurses throughout 
British Columbia, and to solicit their help in the fight against tuberculosis. 

Josephine B. Peters, E.N., 
Tuberculosis Division;, Provincial Board of Health. 



SCHOOL-WOPJv IN FERNIE. 

Another year has passed with all its ups and downs, and I am optimist 
enough to claim that it has been a fruitful year, in spite of the fact that so 
much of what I planned and hoped to do still remains undone. 

In order to accomplish any good in life it is always necessary to look 
ahead and plan carefully, but, after all, meeting each day's emergencies 
and needs takes up most of our time, and the ideal programme is like the 
" Rainbow's End." 

As service is our key-note we must give it where it is most needed, 

and this year I have enjoyed so much breaking trail and exploring new 

fields of endeavour. 

34 



I have conducted child-hygiene and hygiene and health classes in six 
grades — from seventh to tenth— in co-operation with the Home Economics 
Department. The girls all take a very keen interest in the talks and 
demonstrations, and practically all of them did well in their final tests. 
I have been able to give talks to the boys from these grades in the Manual 
Training Department, and they are keenly interested, especially when I 
use the large health posters loaned by the Provincial Health Department. 

Our dental crusade has borne good fruit and the use of the toothbrush 
is much more in evidence. Even in the receiving classes the children can 
discuss intelligently the use of the handkerchief and the teachers take up 
the drills with them. 

This year two of our little ones have been taken in at the Solarium, 
and we are hoping to have two more leave shortly. 

We had a very interesting and worth-while clinic when Dr. Lamb was 
with us, and we hope that, as these clinics continue, the interest of the 
community in tuberculosis-prevention will be more keenly and intelli- 
gently stimulated. Dr. Lamb addressed the high-school students and his 
remarks made a keen impression upon them, and I hope will bear much- 
needed fruit. 

The school staff are splendid in co-operation and most of them are 
up-to-date enough to realize that health is the real foundation of 
education. 

The hospital, the doctors, the dentists, and School Board at all times 
give most cordial response to any call for assistance, and I feel more and 
more, as time goes on, that I am getting the hearty co-operation of the 
parents. 

No matter how much one does, there alwavs seems so much more that 

one should do, but, as " Eome was not built in a day," I suppose the only 

thing a Public Health Nurse can do in the face of all discouragements and 

difficulties is to — - 

Jist grit her teeth. 
An' keep on keepin' on. 

Winifred Seymour,, R.N. 






PERSONALS. 



Miss S. A. Hewertson, Superintendent of Nurses at the Saanich 
Health Centre, resigned her position in July, 1928, and has returned to 
Manchester to take up her former duties there. .Miss E. Naden was 
appointed Acting-Superintendent until further arrangements could be 
made. 

Miss Frances Lyne was transferred from Saanich to Kelowna in 
September, where she is doing school-work. Miss Myrtle Harvey, Nurs- 
ing '28, IT. B.C., has taken Miss Lyne's place. 

Miss M. Johnston, '28, U.B.C., was appointed to relieve on the staff 
of the Saanich Health Centre in December, 1928, due to the ill-health of 
first one and then another of the nurses. She has since become a perma- 
nent member of the staff. 

35 



We regret to announce the receipt of the resignation of Miss M. 
Thatcher, of Duncan. We regret to have to note this as Miss Thatcher 
has been a very valuable member of our staff. Miss Thatcher expresses 
her regret that circumstances over which she has no control have com- 
pelled her to sever her connection with the public-health nursing work in 
British Columbia. Miss Blanche Mitchell takes her place. Miss Mitchell 
has had varied experience, having taught school for two years ; Arts 
Course, University of Alberta, two years; one year in teaching and 
administration, University of British Columbia ; and public-health train- 
ing in the University of Washington. 






VICTORIA, B.C.: 

Printed by Charles F. Banfield., Printer to the King's Most Excellent Majesty. 

1929. 



500-329-5415 

36 



Vv-v 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 

Vol. 1 MAY, 1930. No. 7 




A CHALLENGE. 



u 



What a man wills to do, modified by what he can't 
do, is what he ought to do." — Southard. 

ORDINARILY, this Bulletin has gone to press and is ready for 
distribution before the annual Refresher Course takes place. 
Perhaps it is a fortunate coincidence that it has been delayed this year, so 
that an opportunity is provided to catch again a gleam of the enthusiasm 
and stimulation that surrounded the sessions of this year's institute. 

Do you recall the last illustration Miss Jones employed? One man 
was making " five dollars a day." The second was making his particular 
piece of work, " according to specifications." lint the third was " helping 
to build a cathedral. " To every one of us conies the challenge, kk What are 
you making? ' : The accumulated reports from all our nurses scattered, 
for the most part, in isolated parts of the Province indicate that real 
progress is being made. 

The life of the rural Public Health Nurse is seldom a bed of roses. 
There are so many disadvantages that those of us, who have been brought 
up in cities, particularly, find facing us in our isolated tasks. The indif- 
ference of the great mass of the people; the difficulty of securing treat- 
ment for patients and correction of defects in school-children; the long 
distances to travel on good, fair, and poor roads; the frequent lack of 
suitable living-quarters; the limited recreational and educational facili- 
ties — all these tend to dispel the roseate clouds from before our eyes and 
to reduce our tasks to humdrum affairs. 

But what compensations for a job well done! Perhaps, if we inter- 
pret the outlook of the residents of the rural community in the terms of 
their disadvantages, we would find the reason for their apathy and dis- 
trust at first ; for their cordiality and neighbourliness when they under- 
stand our mission among them. And if the nurse will lead the way, an 
increasing range of activity inevitably opens before the whole community. 
The "cathedral ,1 that will be built will be an intangible building, having 
its being in the increased health, happiness, and welfare of the peoples 
among whom we work. 

Let us all look forward, then, with high hopes for this coming year, 
aiming high, yet realizing our limitations. The challenge is ours. Next 
year's Bulletin should contain a picture of how we have met it. 



TABLE OF CONTENTS. 

Page. 

A Challenge. Editorial 1 

Greetings. By Mabel F. Gray - 3 

The Refresher Course for Public Health Nurses 3 

Oliver, Okanagan Falls, and Osoyoos. By M. A. Twiddy 5 

Esquimalt Rural Nursing Service. By Helen Kelly 

Public-health Work in Fernie. By Winifred E. Seymour 8 

The Saanich Health Centre. By Esther S. Naden 10 

Health Progress in the Armstrong Schools. By P. Charlton 10 

Public-health Work at Sayward. By Edith M. Walls 11 

School Nursing in the Vernon Consolidated Schools. By Elizabeth 

E. Martin 12 

School Attendance in Saanich. By Myrtle E. Harvev 14 

First Impressions of Rural Public-health Nursing. By Olive Ings 15 
Public-health Work in Ciiilliwack Municipality. By Winifred 

E. Green Hi 

Keremeos, Cawstox, and Upper and Lower Similkameen. By Bertha 

Thomson IT 

Saanich Dental Clinics. By Mabel Johnston IS 

Ladysmith. By Hilda Peters 10 

First Impressions. By Mary E. Henderson 20 

Cowichan Health Centre. By Blanche Mitchell _. 21 

French Creek and District. By Margaret M. Griffin 22 

Kelowna School Nursing. By Edith W. Tisdall 23 

Public Health in Kamloops. By Olive M. Garrood ...26 

Child-welfare Work in the Cowichan District. By Anne Yates.... 2!) 

Nanaimo Schools. By Norah E. Armstrong 32 

Port Alberni. By Mary E. Grierson 33 

Publicity in Public-health Nursing. By Margaret E. Kerr .... 34 

Public Health in Nanaimo. By Muriel Upshall 35 

The Development of Public-health Nursing in the Kelowna 

Rural Districts. By Anne F. Grindon _ 37 

University Health Services of Canada. By Celia A. Lucas 41 

Public-health Nursing, Maple Ridge and Mission Municipalities. 
By Hetty E. Fawcett 45 

Personals ,..,..., 48 



GREETINGS. 

It is a great pleasure to have this opportunity of sending a message 
of greeting to the Provincial Health Nurses. 

To any nurse who has played a part in the training of student nurses, 
it is a great satisfaction to see how her graduates are measuring up to 
their responsibilities. Perhaps few people give thought as to how grf j at 
these responsibilities are, but when one considers the functions of the 
Public Health Nurse in a district — as teacher, counsellor, nurse, and 
friend — to what other woman is such opportunity given, and from whom 
is so much exacted? In time of national emergency or disaster the 
appeal for the soldier, the engineer, the doctor, or the nurse is promptly 
answered. The imagination is caught by the spectacular piece of work 
to be done, and public recognition is readily accorded those who so 
promptly answer the call. We admire the courage and the initiative 
displayed. In the calls of the every-day life of a Public Health Nurse, 
and especially in a new district, the demands are not so spectacular, but 
they make an equal demand upon the courage and resourcefulness of the 
nurse, and they also call for great patience and perseverance. It is a 
source of great satisfaction to see the admirable way in which the younger 
women are meeting the call, and how faithfully the more experienced 
nurses are meeting the ever-growing needs of their communities. 

With very best wishes for the steady extension of the public-health 
programme in British Columbia. 

Mabel F. Gray, R.N., 
The University of British Columbia. 



,. 



THE REFRESHER COURSE FOR PUBLIC HEALTH NURSES. 

The annual Refresher Course for Public Health Nurses was held 
in the lecture-room of the Vancouver General Hospital, March 13th, 14th, 
and loth, 1930. Registration this year exceeded all previous records, 
there being 127 persons enrolled. 

The special feature of the Refresher Course was an institute dealing 
with various phases of maternal welfare-work conducted by Miss Anita 
M. Jones, B.S., Assistant Director of the Maternity Centre Association. 

Miss Jones opened the institute with a discussion of maternity care 
in general. She outlined the aims of the service as including: (1) The 
minimum of physical and mental discomfort to the mother; (2) the 
maximum of physical and mental well-being to the mother; (3) the 
reward of a healthy baby. 

The preparation of the average nurse does not fit her to render the 
kind of service that will achieve her aims. In the average hospital the 
nurse's first acquaintance with the patient is at the very end of the 
pregnancy. The nurse must secure further knowledge of the care neces- 
sary during the prenatal period ; of the psychology of the mothers they 
are to care for; of the necessity for early medical supervision. The 

3 



added skills accompanied by an intimate knowledge of her community 
will increase the nurse's usefulness an hundredfold. 

The maternal mortality-rate cannot be taken as the only indication 
of the success of a maternity programme. It is one factor, but many 
other things — -the increased health of the family as a whole, the confi- 
dence of the community in the nurse — these and many other things help 
the nurse to measure the results of her work and to evaluate her 
programme. 

Miss Jones stressed the importance of the nurse discovering new 
cases herself instead of waiting for them to be referred to her. This is 
a difficult part of the programme. It requires tact, skill, endless patience, 
sympathy, and understanding. These are familiar attributes which we 
expect all nurses to have, but which are possessed in varying degrees even 
by the best. 

The second day of the institute was devoted to the problem of group 
discussions — mothers' clubs, etc. The plan for conducting these classes 
was outlined, showing demonstration material and equipment. 

Since the mother is the child's first teacher, and since the habits that 
will govern the whole life of the individual are started in the first year, 
the importance of child-guidance and the formation of desirable habits 
must be stressed by the nurse in her instructions to the mother. These 
things can best be taught before the infant arrives. It is less difficult 
to prevent an undesirable habit forming than it is to break it once it has 
become firmly established. 

Miss Margaret Duffield, Supervisor of the Vancouver District Vic- 
torian Order of Nurses, presented a paper outlining the function of the 
V.O.N, in combating the incidence of puerperal septicaemia. When we 
realize that in Canada approximately 30 per cent, of the maternal deaths 
can be attributed to that cause, an idea of the seriousness of the problem 
can be obtained. 

Dr. J. W. Mcintosh delivered a vevy able address on " Health 
Insurance." He outlined the history of the movement; the distribution 
of the cost; the benefits that would accrue to the employer, the employee, 
the physician, and the nurse. 

Dr. Chisholm, Provincial Epidemiologist, presented a study of the 
place of the Public Health Nurse in epidemiology. He traced her value 
in preventing typhoid, smallpox, diphtheria, etc.; campaigns to get all 
the children protected against diphtheria and smallpox by inoculation and 
vaccination are the responsibility of the nurse working with the Local 
Health Officer. 

At the round-table discussion on Saturday morning, Miss Winifred 
Green, who trained as a Plnnket nurse in New Zealand, presented a 
review of the work of the Plunket nurses. Miss A. M. Roberts, who 
lately arrived from England to inaugurate a nursing service in the Peace 
River, outlined the position of nurses under the Central Midwives' 
Board. 

Considerable interest was displayed in the matter of superannuation. 
It was pointed out that the Provincial Public Health Nurses all receive 

4 



some part of their salary from the Department, and it was therefore 
hoped arrangements could be made whereby nurses would be eligible for 
the privileges of superannuation. 

Transportation problems were discussed under the headings of the 
nurse-owned and the association-owned car. The majority of those 
present seemed to feel the latter provision was more satisfactory. A reso- 
lution was proposed to the effect that in districts where the local nursing 
organization did not provide a car, and where the nurse purchased her own 
car, it should be conceded that she was able to render greater and better 
service by reason of the saving of travel-time and the enlarging of the area 
to be covered. Under these circumstances the local board should take into 
account the character of roads to be travelled in determining the allow- 
ance to be made toward maintenance. In addition, it was felt, a reason- 
able allowance should be made to cover a share of the depreciation and 
the cost of insurance. 

Margaret E. Kerr, R.N. 



OLIVER, OKANAGAN FALLS, AND OSOYOOS. 

We have just passed the first birthday of this branch and the report 
shows quite a volume of work done when we consider that the foundation 
of any work must be slowly and carefully laid in order to have good 
results. It is impossible to measure results by figures to any extent in 
one year, for we have no previous records with which to compare. 

The first two months were largely spent in getting acquainted with 
the people and learning the way about the district to ascertain the needs, 
as these must be known in order to form the programme that suits the 
community. 

The district takes in the area from Okanagan Falls to Osoyoos, with 
scattered ranches and the Inkaneep Indian Reserve. This settlement, 
with Oliver as its centre, is the result of the Southern Okanagan Irri- 
gation Project, which was developed for the benefit of returned soldiers, 
and the greater part of our settlers are returned men who are developing 
fruit-ranches and thus changing a semi-desert into a fruitful valley. 

A new coupe was. provided as means of transportation. We plan to 
visit each school twice a month, these visits totalling 145 in the year. 
There were 229 visits to homes in the interests of school-children. They 
are inspected for cleanliness, signs of infectious disease, and are weighed 
and measured. Those who are over 7 per cent, are given special instruc- 
tion in health habits and a graph on which the weight is marked each 
month. The children in this way become more interested in following 
the rules that will make their line rise to the normal. Three children 
had tonsils removed and four were fitted with glasses. Nine completed 
dental corrections. 

Instruction in mothercraft was given to forty-five girls in four groups, 
home-nursing to one group, and first aid to two groups (17 boys') . Includ- 
ing ten discussions with women on nutrition and diets, seventy-nine 
sessions in all were held for class-work. 



In May a weighing-day was held for babies and small children and 
the nineteen mothers present heard the play "Taking Care of Baby" given 
by one of the groups. The fifteen girls of the group were afterwards 
presented with certificates and pins by Miss McMann, the Western 
Supervisor of the Victorian Order of Nurses. They had by that demon- 
stration and by written examination shown that they know many things 
about taking care of a baby. 

Thirty cases of illness received 194 nursing visits and 14 expectant 
mothers received 02 visits ; 243 visits were made in the interests of babies 
and small children and 816 other instructive and co-operative visits were 
made; the total for the year being 1,544 visits. 

Eight night calls were answered and twenty-six conferences in office 
were held. Fourteen meetings were attended and three addressed. 

The work among the Indians has been mostly instructive, teaching 
them better ways of living, for with them, as ourselves, good hygiene and 
sanitation has a great deal to do with their success in maintaining health 
and battling disease. We think it is a step in the right direction that 
the Indian Department is providing this service, for it will not only 
improve their conditions, but will help to safeguard white people with 
whom they mingle. Tuberculosis in one case has apparently been arrested 
by improved methods of living. The children in the school have responded 
to health-teaching quite satisfactorily. 

We appreciate very much the co-operation of the doctors of the dis- 
trict, the Women's Institutes, and the Board of Directors, whose com- 
bined and untiring efforts have made this work possible. 

Knowing the spirit of the people for "seeing it through" and for 
co-operating in anything they undertake, I have no fears for the success 
of the coming year. With an objective of fencing out or exterminating, 
if he does enter, the " codling-moth of disease " which is likely to enter 
as the community grows, let us all get together and keep our spraying- 
machines ready. 

M. A. Twiddy, R.N. 



ESQUIMALT RURAL NURSING SERVICE. 

We are asked this year to write something along the lines of com- 
parison in regard to present conditions in our district and what they 
were when we came here. We must, to get a comprehensive comparison, 
take some of the various branches of the work separately. 

Take the school-work, for instance. In the first place, when public 
health was first organized in these districts, the nurse was looked upon 
as more or less of an interloper. Her presence in the schools was resented, 
sometimes by the teachers, often by the school trustees, occasionally by 
the children themselves, and also by some of the parents. The idea was 
strong in many minds that the nurse went into the school solely for the 
purpose of finding out " what was wrong " — looking for trouble, in 
other words. Her home-school visits were received in various degrees of 

6 



resentment — with just enough of the other kind to make it worth while 
carrying on. Sometimes merely with toleration. A few were pleased 
and anxious to take advantage of the nurse's visit and to learn what they 
could from it. 

The usual question put to the child who went running home from 
school with the news that " Nurse was at school to-day " was, " Wiry, 
who was sick? " or " What was wrong? " Now, when a child goes home 
from school and mentions the fact that nurse was at school to-day, 
mother invariably asks, " And what did she teach you to-day? " So much 
for the change in trend of thought. Also, to-day, when the nurse goes 
into the homes, whether it be a home-school visit, or a welfare visit, or 
a social visit, there is always — or in most cases — a warm welcome 
awaiting her. 

The number of roadside and telephone consultations on her monthly 
report testify to the confidence now placed in the nurse by the people and 
the value with which her advice and judgment is regarded. So, by way of 
comparison, from practically asking to be allowed to advise in cases 
where it was necessary, we now show hundreds — in fact, in the thou- 
sands — of roadside and telephone consultations during the year, sought 
by the people. 

At our first dental clinic over eighty children received treatment; 
in some cases conditions were so bad that a great deal of time and work 
was necessary to put the mouths of the children in condition. We held 
two big clinics a year for the first three or four years. In comparison, 
the number of children attending the clinics the past year or two has 
been reduced to about thirty-five. We have one thorough examination 
a year by the dentist and a monthly examination by the nurse, and we 
are proud of the report of the School Medical Inspector with regard to 
the children's teeth. 

Before the advent of the public-health nursing system in our districts, 
the report of the medical Health Officer, as published by the Department 
of Health, showed many cases of various defects peculiar to childhood — 
namely, enlarged tonsils and adenoids, defective teeth, hearing, and eye- 
sight, and various forms of malnutrition. This latter was not due in 
most cases to lack of sufficient food, but to lack of sufficient proper food — 
not in any way due to wilful neglect on the part of the parents, but due 
to the fact that they did not know. The parents were not educated then 
to the knowledge that a child, to grow up 100 per cent., must have a 
properly balanced diet and that certain health rules must be observed. 
Now, we are proud to see by that same annual report that our districts 
boast (with one or two exceptions, over which we have no control) a clean 
bill of health. Our children are a credit to their parents, to the district, 
their teachers, and the nurse. Come to our annual Child Health Day 
celebration on May Day and see for yourself. 

Our reports of " nursing fees collected " show a steady decrease; and 
here, lest some one should get the wrong idea with regard to this and 
see a " falling-off of business and decreased revenue," etc., let me say that 
my committee takes the stand that it will not consider this association to 



be functioning 100 per cent, until no nursing fees at all are collected, 
because then all sickness will have been stamped out and we shall have 
a perfectly healthy district. It is not impossible, and we think by that 
time that the people will be quite ready to substitute a little more volun- 
tary subscription through one form or another for the lost revenue in 
nursing fees. 

Schools used to be closed periodically on account of epidemics. Few 
people realize the financial loss sustained through the temporary closing 
of schools. It is long since any school in our district had to be closed. 

But the most important comparison, in my estimation, that can be 
made is shown by the different attitude and outlook of the people them- 
selves. At first the nurse (in any district) was looked upon — to say the 
least — as a necessary evil. It was only the few progressives who managed 
by much hard work and fighting to keep her there. To-day her advice is 
sought and the majority of the people are taking a real and keen interest 
in public health. They realize that better sanitation in our schools and 
elsewhere — public places, etc. — that the decrease in child mortality 
through infectious diseases, and the improved general health of the people 
are not due just to chance, but that it means something that is the result 
of years of study and work and striving on the part of those members of 
the medical profession who foresaw that preventive measures were the 
solution to the health problem. 

In short, the majority of people have accepted the slogan " Preven- 
tion is better than cure " and have adopted it for their own. We still 
have a few of the old school with us — there will always be the few ; but 
we must just look upon them as obstacles to overcome to add a little zest 
to the work. To offset them we have the splendid co-operation of parents, 
teachers, Boards of School Trustees, and that fine body, the Women's 
Institutes. I think, personally, that the comparison between " then " and 
" now " is so great that it might almost be said there is no comparison. 

Helen Kelly, R.N. 



PUBLIC-HEALTH WORK IN FERNIE. 

In asking for a general review of our activities the Provincial Health 
Officer has made me, at least, put on my thinking-cap. I think that look- 
ing at things under separate headings might make for clarity of expres- 
sion and undertaking. 

Control of Infectious Diseases. — This is still a difficulty because so 
many of the people regard violation of the health laws as a very mild 
defection in comparison with the breaking of other laws, but here I do 
think conditions have improved, as, with the exception of a slight epidemic 
of mumps, we have had no other epidemics, and our system of school 
inspection overcomes most of the difficulties. 

Dental Conditions.— When I came here the dental question was a 
deplorable one, but the dentists came bravely to the rescue, and during 

8 



two successive winters we gave each child a complete denial examination, 
using the card system, and the results certainly have been satisfactory. 
I sell toothbrushes in the schools and give frequent dental lectures, and 
I feel that in both cases the work is well worth while: 

Home-school visits. — Through home-school visits the contact with the 
homes is an invaluable means of advising mothers regarding both school 
and pre-school children, and also prenatal care; and it is the best means 
of distributing literature. I have had great joy out of the kindly and 
courteous reception I have received from the people of my district while 
visiting in their homes. 

Co-operation. — I have at all times had the heartiest co-operation from 
the school staff, School Hoard, doctors and dentists, hospitals and socie- 
ties concerned in public welfare. Through association with the Children's 
Aid and Red Cross Societies I have been able to do some social-welfare 
work and have been instrumental in aiding and advising newcomers and 
families in distress. 

Tuberculosis Clinic. — In co-operation with Dr. Land), our tuberculosis 
clinic work has been yi'vy interesting and I feel sure will be productive of 
much good in the future. I find the general attitude toward tuberculosis 
is not nearly so secretive as formerly. 

Solarium. — My contact with the Solarium has been of very special 
interest to me and I have been instrumental in sending down five or six 
of our children for treatment. I also spent a day there last summer visit- 
ing the children and the staff, and knowing the place first hand has made 
it much easier to persuade the parents to let their children go. 

Health Interest. — I have tried to teach health — not so much as 
"health for health's sake," but health as an aid to efficiency and personal 
attractiveness, and the appeal seems much stronger presented in that way. 

The children are very much interested in (heir weights and diets, 
and personal cleanliness, even under difficulties, is much more noticeable 
in the majority of cases. 

During mv first year I took health talks and literature about with me 
and scattered them broadcast on any kind of soil. 1 still do the same, 
more or less, but I find more and more that those really interested come 
to me and ask for it, and I feel that is a step in advance, as it shows 
that they are really interested. Many of the children come to me in my 
office for individual talks and often in small groups of four or six, and 
I feel that these talks perhaps do much more good than longer talks in 
class-rooms. 

()r</auizatioi). — Organization has never been my strong point, and 
1 have hesitated about establishing clubs of any kind, as school lessons 
and church and home duties already take up so much time and energy, 
and leave so little time for outdoor exercise and sport. I feel that taking 
up more time for indoor classes and clubs defeats the very object of 
health-teaching-, but, as the work enlarges, such things may seem more 
feasible. 

(Conclusion. — I feel that the public-health work in Fernie has 
progressed and will continue to progress. It has become a habit with 

n 



the people to make use of its facilities, and, in the school, my office most 
assuredly is the centre to which all the ills of the community gravitate, 
whether physical or otherwise, and I think that at all times the service 
has the confidence and appreciation of the public. 

Winifred E. Seymour,, R.N. 



THE SAANICH HEALTH CENTRE. 

Since the publication of our last Bulletin we have had more changes 
at the Saanich Health Centre. 

Miss Nora Higgs resigned in May to take a position at the Vancouver 
General Hospital. She had been with us nearly two years and was greatly 
missed by all her friends in Saanich. 

Miss Mary Henderson, Nursing '29, U.R.C., was on relief duty during 
June and became a permanent member of our staff in September. 

We now have a staff composed of a full-time Medical Health Officer, 
half-time School Dentist, and four Public Health Nurses. Two nurses 
are kept busy with school- work, while the other two take care of the bed- 
side nursing, child-welfare, and prenatal work. This division of work is 
arranged arbitrarily so that each nurse does a certain amount of gen- 
eralized nursing, and overlapping is avoided. 

Our old Ford roadster has been turned in and we are now the proud 
possessors of a 1030 Chevrolet coupe. We also have a 1929 ford touring 
and an old-style Ford touring popularly known as the " Death-trap," 
which, in spite of two fairly serious accidents, has not become per- 
manently disabled. The newest member of our staff looks longingly at 
the new coupe and wonders if she will ever have a decent car to drive. 

The Health Centre buildings have been repainted and the grounds 
considerably improved during the past year. 

Our committee has done everything possible to further the health- 
work in our community and we are greatly indebted to its members for 
their co-operation and assistance. Our gratitude is also extended to the 
Provincial Health Officer for his never-failing help. 

Esther S. Nadex, R.N. 



HEALTH PROGRESS IN THE ARMSTRONG SCHOOLS. 

It has been said that health, like happiness, is to a large extent a 
matter of habit and that it can be taught. One of our English teachers, 
an exchange, says that our pupils' aspect toward health was one of the 
first things she noticed in our school. She said: "The children here 
seem to be vitally interested in health." What we have aimed at is not 
information, but action ; not simply knowledge of what things are desir- 
able, but the daily practice of the rules of healthy living, and I think 
I can truthfully say we have made progress in this respect. 

10 



The school attendance is good. This past year has been our best. 
The success of a school-health programme is shown by the health of the 
pupils. 

For the past five years the drill prize given to the best class in this 
inspectorate has been given to Mr. Aldworth's class. No doubt this is 
owing to his efforts, but it also shows that the health of his pupils must 
be up to standard. 

During the past five years a great many defects have been remedied. 
There are still many to be corrected, but perhaps the zest would be taken 
out of life if we reached perfection. In June we hold a pre-school clinic 
for the beginners starting in September, so that the defects found may be 
corrected before the child starts his school-life. 

Before the Public Health Nurse's time a very small percentage of the 
pupils had ever had dental treatment. Dental clinics were held twice 
weekly for two and a half years. Unfortunately, we have no dental clinic 
at the present time, but a goodly number make their periodic visits to 
the dentist. 

Dr. Lamb's chest clinics have been a great help. We have had sixty 
pupils examined, with as many re-examinations. Three children were 
sent to Tranquille for several months' treatment. 

Up until 1925 there was little or no vaccination for smallpox. My 
predecessor started it and we have continued vaccinating the new pupils 
every September. 

One of our best health projects in the senior grades was that in first 
aid. Eight teams, boys and girls, were chosen from the four senior divi- 
sions. We had the competition on the day of the cadet inspection. The 
teams were judged by both our local physician and the Cadet Inspector. 
When the latter's report came we found our cadets had come second in 
first aid in the Province, being beaten only by a high-school team in 
Vancouver. The winning teams were given cups, which are to be kept 
for a year, when the competition will be repeated. More progress was 
made in first aid over this project than in all the rest of the time put 
together. 

Quite an influx of foreigners has invaded this district during the past 
few years. They show great improvement in every way, especially in 
regard to cleanliness of person and clothing. The Inspector during his 
last visit remarked on the change. Surely we are doing a real service 
to the country if we can show these new Canadians the way to better 
citizenship. 

P. Charlton, R.N. 



PUBLIC-HEALTH WORK AT SAYWARD. 

In the year 1921 I was appointed District and Public Health Nurse 
for Sayward. On visiting the schools I found little attention had been 
paid to persona] hygiene amongst some of the pupils. There was a great 
deal of prejudice towards the nurse. However, I am able to say that 
a great deal of that has disappeared. The children were asked to bring 

11 



individual towels and drinking-cups, and a filter was placed in tlie school. 
This was donated by the Women's Institute. 

In 1927, when the schools were visited by Dr. Watson, of the Coast 
Mission ship kk Columbia, " he commented upon the greater cleanliness and 
better health of the children than in the schools not visited by a Public 
Health Nurse. 

The first two years of my work I was unable to get a visiting dentist 
to attend to the children's teeth, but the following year the Provincial 
Board of Health helped me considerably in locating a dentist who would 
visit Sayward and combine work with a holiday, all the children getting 
their teeth attended to. We have had a dentist in every year since, with 
the exception of one year. This, I think, has been the means of the 
children keeping in good health, as many of the parents would be unable 
to visit a city to ( ^et dental work done for the children. 

There has been but little prolonged absence from school on account 
of ill-health, with the exception of two surgical cases and one eye treat- 
ment, where prolonged observation and hospital treatment were necessary. 

The improvement in the health of the children is due to the intelligent 
interest taken by the majority of the parents and children in their ability 
to stay in such a long stretch of health as will allow of constant atten- 
dance at school. 

The foundation of a Junior Red Cross League has helped to create 
an interest in the health of themselves and other less fortunate children 
who need assistance. 

We are fortunate in not having had any epidemic of infectious dis- 
eases among the children or in the schools. 

I have observed that some of the children need more physical drill 
than they sometimes get in the rural schools, owing, I think, to the 
teacher having so many grades to teach that sometimes drill is left out. 
There has been an experienced teacher appointed lately to the Upper 
Sayward School, who gives the children physical drill daily, and I hope 
this will straighten up some of the children. 

Edith M. Walls, R.N. 



SCHOOL NURSTNG IX THE YERXOX CONSOLIDATED 

S( MIOOLS. 

In the first survey of the high school in 1025 it was found that 10 
per cent, of the pupils had defective teeth; by 1929 this condition had 
so improved that very little dental work was necessary. In 1925, in the 
public schools, 20 per cent, of the children were found to have defective 
permanent teeth or bad gum conditions; last year it was very much the 
exception to find defective teeth among the children who had been resident 
in the city for any length of time. 

There are many reasons for this improvement: the greater number of 
articles appearing in the press on the harmful effects of defective teeth; 
the stress laid on cleanliness and the regular use of the toothbrush by the 
School Xur.se and the teachers, especially by the teachers of the lower 

12 



grades of the school ; the establishment of a dental fund that has made 
it possible to give to the indigent pupil the same privileges that are 
enj^ed by the more fortunate children; and the increasing interest of 
the parents in the general welfare of their boys and girls. Many parents 
now realize the importance of frequent dental examinations, which will 
undoubtedly result in better health conditions throughout the schools. 
In the public schools, work was begun first in the receiving classes ; last 
year attention was given to all children in the school who had defective 
teeth. Much good work has been accomplished by the Junior Red Cross 
as well as by the teachers and the School Nurse. 

In 1925 the School Health Officer found about 10 per cent, of the 
children suffering from goitre. At the present time not more than 2 per 
cent, of the children are affected, and there is not a bad goitre condition 
in the schools. Where it exists at all it is among children who have 
come to us from outside points or among the children of the receiving- 
classes. Iodine treatment was given for two years previous to 1925 with 
good results, and this treatment was continued for some time; but it is 
not every child who can take this treatment and we have been careful 
in giving it to children over 12 years of age. I always advise taking it at 
home under the advice of a physician, and in cases where I know that the 
child is not receiving any treatment, and is not likely to, I give it at 
school on the advice of a physician. The improvement in this connection 
is due in large measure to the annual inspection by the school doctor, the 
follow-up work of the nurse, the increased interest on the part of the 
parents, and to health propaganda. Goitre has decreased very rapidly 
in the Vernon schools. 

There have been mild outbreaks of contagious diseases during the 
past five years, but nothing of a more serious nature than a mild out- 
break of mumps in the fall of 1927, and of rubella in the early part of 
1928. Much of the credit of this is due, I think, to the medical men of 
this city, who have at all times been active in the prevention of epidemics. 

More attention is now being given to diseased tonsils. There is still 
room for improvement here, but the number of bad cases is decreasing 
rapidly. Greater attention is given to diseased tonsils during the pre- 
school age. 

Dr. Lamb, Travelling Medical Health Officer, visits this district about 
once in every four months. All contacts are gathered in and with the 
consent of their medical adviser are taken to the clinic. No case of active 
tuberculosis has so far been found in the Vernon schools. 

During my first two years here I tried to cover the district- work in 
addition to the school-work, but the district was so large that I found 
that I could not do justice to both. I have therefore concentrated on the 
schools and the follow-up work. I visit twenty class-rooms each week, 
take a lesson in health with each class, and endeavour to get the children 
as interested as possible in this subject — as interested as they are in 
other subjects of the curriculum. I get the finest co-operation from every 
member of the staff, and this is particularly evident in the general cleanli- 
ness of the children throughout the school, which I attribute in large 

13 



measure to the interest which the teachers take in the health and cleanli- 
ness of the children under their care. I would like to see the Junior 
Red Cross organized in all the grades, as I think it one of the best health 
organizations that Ave have. 

On the whole the Vernon school-children are clean. We have careless 
families, and these have increased with the large influx of New Canadians, 
thus adding to our work ; but most of these families are willing to accept, 
and to act upon, the advice that is given them; are very anxious, indeed, 
to do anything that will keep their children regularly at school. In 
regard to skin-diseases, T cannot say that the number of cases has 
lessened; I believe they have increased. This is due, however, to a few 
families that will not keep their homes clean. No matter how often the 
children of such homes are cleaned up, the diseases repeatedly recur 
because of the prevailing conditions at home. 

Two well-baby clinics are held each year and literature is distributed 
to the mothers. 

One of the most noticeable things is the increased interest of the 
parents in the health of the children and their readiness to help and to 
co-operate whenever they can. I would like to add, also, that the sym- 
pathy, advice, and co-operation which I have always received from the 
principals, the teachers, the School Board, the Department of Health, 
and the public generally, has made my work here possible and a source of 
great happiness to me. 

Elizabeth E. Martin, R.N. 



SCHOOL ATTENDANCE IN SAANICH. 

Since the establishment of the full-time health unit at Saanich, sta- 
tistics are beginning to prove interesting. With the help of an adding- 
machine, we spent two days estimating the attendance of the school- 
children of Saanich for the past five years, and the results we found were 
most encouraging. 

Owing to changes in the staff and unavoidable loss of time in filling 
the vacancies, the staff was short-handed most of the time during the 
school term 1027-28. In the spring of 1029 there were epidemics of 
measles and mumps in the four largest schools, so that even with the more 
complete staff there was no increase in the attendance over that of the 
previous year. 

In spite of these difficulties, however, we found that since September, 
j 927, when the full unit was organized, there has been an increase in the 
school attendance of 11 per cent, as compared to the attendance of the 
three previous years. Such a marked increase did not just happen, and 
any one interested might wonder by what methods this has been brought 
about. 

In the first place, we are obliged by the School Board to investigate 
the causes of absence of those children away from school for three days. 
Before readmittance to the schools after three or more days of absence, 
these absentee children are required by the teacher to have a certificate 
from the nurse. These methods not only do away with needless absence 

14 



due to trivial reasons, but they also lead to the discovery of communicable 
diseases and skin-infections which otherwise might be concealed and 
therefore spread. In this way a case which might be the start of an 
epidemic is kept at home until infection is past. 

Time is also saved by the treatment and inspection of minor skin- 
infections at the schools by the nurses, and thus children affected are 
allowed to be present without being menaces to the other children. Again, 
mothers who are anxious to have their convalescing children lose as little 
time as possible at school are advised to keep them home longer than they 
might have done, and consequently time lost through relapses is avoided. 

Another method by which the attendance is increased is the adoption 
of the infectious-disease regulations, whereby the contacts and exposed 
children are permitted to remain at school during the non-infectious incu- 
bation periods. This has worked very successfully in Saanich. 

All this, of course, required a great deal of time, and consequently 
a larger staff of nurses, but we feel that the saving of school-time and 
the decrease in retardation owing to unnecessary absence more than makes 
up for the added expense. 

Myrtle E. Harvey, R.N. 



FIRST IMPRESSIONS OF RURAL PUBLIC-HEALTH 

NURSING. 

Just about a year ago I was in the throes of preparing for examina- 
tions at the University of British Columbia, wondering if I should be 
lucky enough to win the much coveted certificate for public-health nursing. 
Now I have actually reached ray goal — I am a Public Health Nurse. 

When I first caught sight of the steep snow-clad hills of Peachland 
I said to myself: il Will I ever screw up nerve enough to climb those hills 
in a car?' Having just arrived from Vancouver, where I had been 
accustomed to driving on flat, cement roads, I felt transportation would 
be one of my main difficulties in a rural district. I soon found that my 
fears had not been groundless. More than once, when I started out on 
one of those icy roads, I felt like turning tail. I used to think, "if only the 
snow would go" : and the next thing I knew I was experiencing the joys of 
being stuck in the mud. However, all things come to an end some time, 
even bad roads, so I heave a sigh of relief when I realize winter is almost 
gone and spring is on the way. 

As I have only been six weeks in this district I have not much to 
relate. My district is about 50 square miles, consisting of Westbank, 
Peachland, and an Indian reservation. There are three schools and the 
population is about 1)00. 

The first month was spent largely in finding my way around and in 
calling on the local people. This month I started work in the schools. 
At the request of the Women's Institute, a class in home-nursing Avas 
organized for women and 'teen-age girls. 

I am much interested in the work amongst the Indians, as there is 
much to be done for them. The Indians in this district are extremely 

15 






poor and for the most part shiftless. Shortly after my arrival the 
83-year-old chief became very ill with the flu. For a time I feared he 
might not pull through. I was afraid he might not be willing for me 
to nurse him, but he proved to be a very good patient. The old chief 
could not understand a word I said and his wife spoke broken English, 
so vou can imagine our conversation was very limited. The first visit 
I made the house was very upset, but the next time I called his wife had 
tidied things up and there was a huge tub of hot water in readiness for 
me. She announced : ik The old man wants a swim." So, of course, the 
patient got his wished-for bath. Having once helped this family they 
proved very appreciative. 

Shortly after my arrival in the district the ferry stopped running for 
three weeks, so except for the daily C.P.R. boat we were cut off from 
Kelowna, our nearest town. Some one said to me: "I am not worrying, 
seeing we have a nurse now." However, I may add that I did not share 
her optimism, as I was not in the least anxious to practise first aid. 
I did, however, have one emergency, a broken wrist, and I managed to 
make a temporary splint out of an orange-box. 

When the Bulletin is published next year I hope to be able to show 
results. Meanwhile I am looking forward to a year of varied experiences, 
trusting that I will meet with success in my work. 

Olive Ixgs, R.N., 

Wcstbanlc. 



PUBLIC-HEALTH WORK IN CHILLIWACK MUNICIPALITY. 

The farmer is supposed to be a cautious buyer (possibly because the 
wherewithal is earned through such hard work). One finds this very true 
when endeavouring to sell him public health. He regards one as an 
unnecessary nuisance, who will, in all probability, raise his taxes and 
possibly l> investigate " his home. One has no definite proof of value to 
show him for many months, and statistics and reports are waste paper 
to him ! 

Contagious- and skin-disease statistics are apt to be unfavourable, 
too, the first year. Our list was higher, possibly, this year than previ- 
ously, when many cases had escaped detection. 

The City of Ohilliwack, with no School Nurse, reported " no epidemics 
or contagious disease," whilst one heard of this child and that away sick, 
and met whooping-cough, mumps, and impetigo on the streets. 

Ohilliwack is fortunate in having many active women's organiza- 
tions ; an Auxiliary of representative members from various organiza- 
tions supporting public-health schemes meets monthly. 

The annual report shows that our efforts have not been in vain : Nine 
eye clinics held, 30 examined ; 52 tonsil and adenoid operations, many of 
long standing; 2 visits paid by Dr. A. S. Lamb, Tuberculosis Diagnosti- 
cian, 100 examined. Fortunately the positive results were few, the majority 
being contacts and suspects. Twelve well-baby and pre-school clinics 
held, under local doctors — 17 babies, 60 children attended, (> vaccinated, 

16 




21 i Him u n i zed; 124 visits to infants; 52 visits to pre-school children; 
\y 24 visits to prenatal cases. 

The Auxiliary sponsored a baby-show, rest-room for mothers, and 
creche at the annual fair. The latter, with cots and sand-piles under 
supervision of Girl Guides, was a boon to many tired mothers. Visitors 
showed great interest in the posters, model feeding equipment, layette 
and bassinette, and quantities of literature were distributed. The Pro- 
vincial Board of Health kindly permitted Misses H. and J. Peters to 
assist, which assured expert attention to all inquiries. The interest 
taken by the public, and particularly by mothers, we all felt well repaid 
our efforts. 



Winifred E. Green, R.N. 






KEREMEOS, CAWSTON, AND UPPER AND LOWER 

SIMILKAMEEN. 



' 



' 



Having been here for only seven weeks, I am sorry I cannot write 
of many things accomplished, except that I have got the lay of the land 
pretty well and am getting to know the people and their needs fairly well. 

Most of the people at Keremeos and Cawston are British born. They 
are not very well off financially; therefore the cost of illness is hard to 
bear; but they are good home-makers and have the welfare of their 
families at heart. 

There are not many organizations. Keremeos and Cawston have 
each a Women's Institute. Besides there is a " Guild," Church of 
England, and a Ladies' Aid. The women of the institutes seem very 
progressive and willing to help in the cause of public health. 

Upper and Lower Similkameen are Indian reserves. 

The first four weeks I spent here I had a great many nursing visits to 
make — mostly colds, one case of pneumonia, and four cases of scarlet 
fever. 

We are handicapped this winter by having no doctor nearer than 
Penticton, 33 miles of slippery mountain roads. We have no dentist 
either. 

In a case of illness the mothers are quite upset when a member of 
the household falls ill. The nurse is the next best thing and is called 
upon at all times. 

The child-welfare work starts with prenatal advice, through infancy 
and school-years. Very few of the mothers are confined at home. Most of 
them go to hospital. Most of the children are well nourished and bright. 
I weigh the pre-school underweights once a month and do my best to 
persuade the parents to correct defects before the child enters school. 

T visit each school-room once a week, inspect the children for general 
cleanliness, for skin-diseases, sore throats, and other noticeable defects. 
Following inspection, I give a short talk on an appropriate subject. 
I weigh all children in the junior grades once a month, in Grades IV. 
to VI IT. the underweights only are weighed. I make out weight-tags for 
each child. 

I am hoping to evolve some plan to solve the dental problem. Many 

17 



of the children have poor teeth. Some of the people are in favour of a 
dental clinic and with a little explaining and some persuasion we shall 
have one vet. 

I am starting a first-aid class at Cawston and Keremeos, and hope 
to have a Little Mothers' League class too, hut we need a more adequate 
outfit for demonstration. 

At Cawston School the children make hot cocoa for lunch. They are 
also buying wash-basins and soap-container for a wash-room. Up to now 
the children have washed at the pump outside. Drinking facilities con- 
sist of a fountain in the school. 

Many of the mothers at Keremeos and Cawston have decided to have 
their children immunized against diphtheria. The Women's Institute at 
Cawston has asked me to discuss " toxoid " and immunization at its 
March meeting. There will be a doctor available at Bedley (20 miles) 
some time in April. 

My Indian work consists of child- welfare, instruction regarding 
taking the " cure," and protecting others from tuberculosis. I also make 
nursing visits when necessary. 

The work is interesting and with time and patience may prove well 
worth while 

I hope by next year to be able to give the Bulletin a better report 
of work actually accomplished. 

Bertha Thomson, R.N. 



SAANICH DENTAL CLINICS. 

When the school dental clinic was first started in Saanich it was 
held at the Health Centre. In their monthly inspections of the school- 
children the nurses noted the work to be done. The children whose 
parents gave their consent were brought to the Health Centre for treat- 
ment. This did not prove altogether satisfactory owing to the expense 
of transportation, waste of the nurse's time, and waste of the child's time, 
as every trip to the dentist meant about half a day away from school. 

It was decided that this could be avoided if the dentist worked in 
the schools. Portable dental equipment was obtained and is set up in 
the teacher's room of the various schools. The dentist first made a survey 
of the children's teeth and recorded on the dental cards the work to be 
done. The cards were sent home with the children and the work was 
done for those who brought back signed cards. This proved very expen- 
sive as the collections were poor. The School Board did not wish any 
child to go without dental treatment because his parents were unable to 
pay for it, but it felt that a great many people who could afford to were 
not paying their dental bills. 

Home-school visits by the nurses seemed to be the only solution to 
this difficulty. So now when the dentist goes to a school he is accom- 
panied by a nurse. A survey is made of the entire school before any 
work is done. The cards are then grouped into families. The children 
requiring very little work to be done and those we feel can afford to have 
the work done take their cards home. Home-school visits are made on 

18 



all the rest. Some we find are able to pay for this work immediately. 
Others are willing to have the work done, but cannot pay for it at the 
time. These are asked to sign a promissory note. There are a surprising 
number of people who are able to pay if they are given a few months' 
time, and the fact that they have signed a note makes them remember the 
obligation. Still others we find are unable to pay, but would like the 
work done. These get it done free of charge. The children whose 
mothers receive the mother's pension are done free of charge without 
question. The children who have taken home their cards and do not 
return them are questioned, and to those who are not receiving treatment 
from their family dentist a home-school visit is made. 

Lack of funds is the greatest obstacle in getting dental work done, 
but carelessness and indifference are also a great factor. The personal 
visit of the nurse will usually overcome these difficulties. 

This system has been followed for nearly two years and when the 
dentist has completed a school most of the work has been done. 

We have found in doing the work for the beginners that a great deal 
of the time had to be spent on work which should have been attended 
to in their pre-school days. In many cases the teeth have been neglected 
so long that extraction is the only possible treatment. The Health Centre 
Committee, assisted by the Provincial Board of Health, is starting a pre- 
school dental clinic at the Health Centre. We hope that a great deal of 
the temporary work will now be done. This will save many teeth and 
will give the dentist more time to spend on permanent work and to make 
more frequent visits to each school. 

Mabel Johnston, R.N. 



LADYSMITH. 



The badly depressed condition of this district has prevented any great 
strides being made in the work here. Three new schools, however, have 
been added to my list, the Government being willing to stand the cost of 
transportation for the present. This linking-up of the schools is bound 
to be beneficial. In these schools, where there has been no nurse and a 
dental clinic is unknown, I was struck with the very bad condition of 
the mouths of pupils. 

Our dental clinic in Ladysmith has been very successful and could be 
extended to include some of the country schools. This suggestion was 
made to two School Boards near by last summer, but was not taken up. 
The number of pupils who made use of the clinic last year was very much 
ahead of any previous year. Having again been allowed the Government 
grant this year, we have extended the work to include the high school. 
Our dentist, Dr. Yerchere, found it possible to make appointments with 
pupils and so do this work in his office alter school-hours. This service 
was made of great use by the pupils. We are very fortunate in having 
a dentist who is very well suited for clinic work. 

More and more parents are appreciating the annual examination and 
having the work done. They seem glad to discuss their children's defects 
and learn about the teeth. One cannot help feeling that this regular 

10 



dental care is a great step forward in training the children. I find also 
the benefit of having a dentist in attendance during the year, as any suit- 
able cases can be referred to him. The great value of the clinic is realized 
when one reflects on the small percentage of the work which would be 
attended to if it were not brought before the parents in this way. The 
local I.O.D.E. Chapter has become interested in this work and is giving 
a substantial donation. The amount of work will be no doubt greater 
even than last. 

This year I have been put on the regular schedule for teaching hygiene 
and every two weeks take the upper grades. This gives great opportunity 
for health-teaching, besides making it unnecessary to interrupt classes. 
The health-poster competition was very successful this year, some really 
fine work being done. 

Since my stay in Ladysmith we have had no real epidemics of any 
kind. This has, of course, simplified my work very much. Parents are 
becoming more and more used to the School Nurse and are, I find, as a 
rule, easy to deal with. 

The baby-welfare work has increased considerably, but with two 
doctors in the town the mothers get excellent advice, which leaves less 
for the Public Health Nurse. 

At the fall fair literature of many different kinds was placed in a 
prominent place and seemed to be appreciated. 

Hilda Peters, R.N. 



FIRST IMPRESSIONS. 

I have now been engaged as a Public Health Nurse in Saanich for 
eight months. I came here immediately after graduating at the Univer- 
sity of British Columbia and my experience has been varied and instruc- 
tive. There are four nurses at the Health Centre ; I am the latest addition 
to the staff and therefore the " greenest." 

The nature of the work is explained to us in college lectures, but 
mere oral descriptions do not compare with experience in giving one an 
idea of the wide and inclusive nature of the work. As far as the academic 
part of the Public Health Nursing Course and the training in nursing 
procedures are concerned, I felt I was well able to fulfil my duties. But 
I did not realize how much I had yet to learn of the common ailments 
of the community. One of the most surprising of my discoveries was the 
number of rashes and spots which are not infectious; for example, the 
various forms of urticaria, heat-rashes, etc. Will I ever find the end? 

Surely in no other form of work is the experience so wide and inter- 
esting. Such a host of* practical knowledge have I picked up in the last 
eight months! The more I learn the more I realize just how much I have 
still to find out. It is all very overwhelming at times, and my sincerest 
sympathy goes out to the new graduate " turned loose " in a district of 

her own. 

Mary E. Henderson, B.N., 

Saanich Health Centre. 

20 






COWICHAN HEALTH CENTRE. 

I think it is very difficult for a Public Health Nurse to see " results " 
of her work, or the effect her work is having, unless she remains in a 
district for several years. It is by looking back over a period of years 
and comparing, that results are really seen. 

Public-health nursing is discouraging at times, especially when you 
cannot see immediate results. But when you realize that it is for the 
future you are working and that all educational work is done slowly, then 
the horizon doesn't seem dark, but very bright indeed. Recently I have 
had the pleasure of seeing results in child-welfare work due to untiring 
work of nurses in the previous years. Every week more mothers keep 
coming for advice and our monthly well-baby clinic has grown rapidly. 

Not long ago I was asked by a friend: "Is your work worth while 
and are you accomplishing anything? ' I endeavoured to explain just 
what we are doing at the Cowichan Health Centre and left her to judge. 

There are three nurses on the staff and we have two Ford cars 
(Phoebe and Mary), faithful or faithless, according to the condition of 
the roads. We do bedside nursing, child-welfare work, and school nursing. 

Needless to say, bedside nursing keeps us fairly busy. That at least 
is one branch that grows without any educational work. We do all the 
nursing for the Metropolitan Insurance Company, also answer all calls 
to sick persons, giving nursing care at the initial visit, but continued only 
when a qualified medical practitioner is in attendance. 

Child-welfare work is beginning to show results and this will be dis- 
cussed in another article. 

We visit fifteen different schools (1,400 pupils), varying in distance 
from 5 to 25 miles. Class-room inspections are given monthly, followed 
usually by a health talk. The children are weighed and measured twice 
a year and eyes and ears are tested once a year. This year we have been 
able to test all eyes in Grade 1. by using the Snellen " E " chart, and 
the little ones love to show which way Ihe legs of the " E " point. All 
children are given a physical examination yearly by the School Medical 
Officer appointed to the different school districts, assisted by the nurses. 
Follow-up visits are made in the homes to acquaint the parents of any 
defects found. 

School nursing is the most hopeful and the most discouraging branch 
of our work. After summer vacation .Johnny is asked whether he has 
had his tonsils out as advised, and he replies: " Nope, Pop bought a car 
instead." However, the mere fact of having the privilege of teaching 
Grades I., IT., and III. makes the future look bright. A lesson was taught 

I to Grade T. on the use of the handkerchief: " When you cough or sneeze 
or sniff, do it in a handkerchief, etc." Next day was Mary's birthday and 
she could hardly wait to show the nurse six new white handkerchiefs 
given to her by her mother and a brand-new pocket put in her dress. To 
be sure, Mary hated to unfold those beautiful handkerchiefs, but at least 
that was one health habit that had a fine beginning. 

Little Mothers' League classes have been carried on in different 
schools. Just before Christmas several proud little mothers, after having 

21 






a written examination followed by a demonstration, received certificates 
issued by the Provincial Board of Health. 

Interest in the nurses 1 teaching is not confined only to school-children. 
Young mothers in one of our outlying districts are asking for information 
concerning infant-care and the prevention of disease. 

Cowichan Lake is on the extreme edge of Cowichan District and two 
new towns have recently sprung up along its edge. Once a year a nurse 
from the Cowichan Health Centre accompanies the doctor to these new 
lumber towns (a long journey by car and boat) to assist him in his 
medical examination of the schools. Now the people are wanting more. 
They want a nurse of their own for these new towns and they have been 
advised to write to the Provincial Health Officer. The people are pro- 
gressive and the employers interested in the welfare of their workers, and 
I think in the near future there will be a new opening for another Public 
Health Nurse. 

Blanche Mitchell, R.N. 



FRENCH CREEK AND DISTRICT. 

I feel that I cannot make comparisons between past and present 
conditions in my community, for so much of the real foundation was laid 
by my predecessors. As has been said before: " It is difficult to measure 
progress in public-health work.'" 

One of my hardest tasks is getting the expectant mothers to report 
early in pregnancy. Quite frequently they will tell me: "But don't say 
anything to the doctor until nearly the time; it is so foolish going to 
him when I feel quite well." Statistics in this, as in many other things, 
prove to be my most valuable ally, for the people are appalled at the 
infant and maternal mortality which is preventable. In some cases, 
where there is the transportation difficulty, I find that it is time well 
spent for me to take the prenatal case to the doctor at regular intervals. 

The community is too scattered and transportation too inadequate to 
permit of well-baby clinics, so I find that regular home-visiting is my only 
recourse. There is an ever-increasing tendency on the part of the mothers 
to consult with the nurse where the welfare of their babies is concerned, 
especially with regard to the feeding. They are coming to realize the 
importance of properly prepared and supervised feedings, just as they 
realize that convulsions and colds are not a necessary adjunct of the 
process of teething. 

I think that, without an exception, the community appreciates the 
nurse in the schools. I am very gratified at the readiness with which 
parents will report any indisposition amongst the children. " I did not 
send Charlie to school, nurse, until yon had seen him. It seems like a 
cold, but one never knows — and then colds are better at home, aren't 
they?" And amongst the children, too, as they are increasingly educated 
to the idea of prevention, the desire is more prevalent to protect their 
playmates from preventable disease. Of course there is the occasional 
person who still clings to the idea of " let them have it while they are 



young, and then it will be over and done with"; but fortunately they 
are very rare. 

The correction of dental defects is slow, but nevertheless there is 
a marked improvement. Unfortunately, I have not to date been able to 
devise a means whereby T can have a dental clinic, so all work must be 
attended to in the nearest town, which is approximately 30 miles away. 
Some of the parents can attend to the transportation of their children, 
while others without cars, or with the fathers away all day and other 
small children in the family, are taken to the dentist by the nurse. 
A number of 'teen-age lads have worked and saved especially so that they 
could have their teeth attended to. 

I held a series of twelve classes among the French Creek school- 
children in elementary first aid. It was very well attended and the 
youngsters acquitted themselves very creditably. Little Mothers' classes 
had been conducted by my predecessors, so it will be some time before 
there are sufficient girls of an age for such a class. A course in home- 
nursing was given in Hilliers District last spring, and I have now begun 
another in the French Creek District. A mother informed me that the 
early detection and isolation of a scarlet-fever case in her home was due 
to the lesson I had given them on communicable diseases; that the instruc- 
tion had driven home to her the fact that she should never take any 
chances on a sort throat. 

I am sorry to say that there seems to be an ever-increasing tendency 
towards bottle-fed babies. Do what one will, the cry seems to be even 
more frequent: "My milk is just going in spite of me following your 
instructions." Is it because so many mothers of to-day will not forego 
their usual dancing, badminton, etc.? It is so difficult to make some of 
them realize their responsibility in this respect. 

I cannot speak too highly of the co-operation I have received on all 
sides. The doctors, and especially the local Medical Officer, with whom 
T am brought into close contact, are every ready to help and advise me. 
The Women's Institutes have never refused any request for help for my 
charges, whether it was boots, milk, or cod-liver oil for the under- 
nourished child; teeth to be attended to where finances would not permit; 
or many other things that would otherwise be very difficult for me to 
obtain. I have had every consideration from my Health Board, and last, 
but not least, I must mention the Provincial Board of Health, to whom 
I feel very grateful for encouragement and help at all times. 

Margaret M. Griffin, R.N. 



KELOWNA SCHOOL NURSING. 

The year 1020 has been an eventful and busy one in the School Dis- 
trict of Kelowna. At the beginning of the fall term the new Junior High 
was formally opened by the Minister of Education, the lion. Joshua 
Hinchliffe. The building is of an imposing structure, containing nine 
class-rooms as well as a large gymnasium and auditorium, domestic- 

23 



science and manual-training rooms, a library, and last, but certainly not 
least, an office especially for the School Nurse. The latter is a very much 
appreciated addition after the cubby -holes and corners it has been neces- 
sary to use before. The nurse's office is the official headquarters for all 
minor treatments, although each school — that is, the primary, elemen- 
tary, and senior high, is provided with a first-aid outfit in case of 
emergencies. 

The outstanding work of the year has been the dental survey. One 
can hardly call it an achievement, since the undertaking has not yet been 
completed, and, although much has been accomplished, there is still much 
to be done. The work was started early in the spring. The four den- 
tists of the town were consulted and agreed to lend their co-operation 
whenever possible and necessary. The school-children, numbering some 
850, were arranged in groups and definite assignments made to each den- 
tist. By the end of the term the examinations were all completed and 
the dental notices, with the estimated cost, sent out to the parents. Out 
of the total number of pupils examined, barely per cent, were passed as 
needing no work done on their teeth. In other words, 94 per cent, of 
the school-children needed dental care! Since the summer many of these 
cases have received treatment and the results are more than gratifying in 
the improvement of the general health of the children. 

The month of December was taken up with preventive work, immuniz- 
ing the school-children against scarlet fever. As may Avell be imagined, 
this involved a great deal of time in arranging and organizing. Notices 
were first sent out to all the parents, explaining the procedure and asking 
for their written consent to the undertaking; 1)50 of these were sent out 
and returned with the necessary information. A table was then arranged 
as to the time and place of the first Dick tests and subsequent inoculations, 
and these sent to the parents whose children were to receive the antitoxin. 
These children were given the Dick test and all negative results elimi- 
nated. The inoculations were then given in five doses, each dose usually 
about ten days after the preceding one. Altogether there were 1,758 
inoculations given, exclusive of the Dick test, and 297 children treated. 
Besides these there were forty-one pre-school children tested and eighteen 
of these given the inoculations. After the completion of the immunizing, 
nine of the senior high-school pupils were again given the Dick test and 
the result in each case was negative. 

Besides this, sixteen school-children have been immunized against 
diphtheria. Later in the year Dr. Ootmar, the Medical Health Officer, 
intends to undertake a procedure similar to that of the scarlet-fever 
immunizing, and administer diphtheria toxoid to all the school-children 
whose parents so desire. 

The actual work undertaken in the schools is more or less of a routine 
nature. Yearly examinations are made by the School Medical Officer, 
Dr. Knox, and as far as possible each class is given a monthly inspection. 
The absentees are checked up every Monday morning and every pupil 
absent for two days or more is required to receive a written permit, signed 
either by the doctor or myself, before returning to school. In this way 

24 



infectious diseases are kept checked up. A cop} r of every note sent home 
to the parents by the examining doctor is kept, and in this way much 
more satisfactory work may be done, when home-school visiting, in cor- 
recting the plrvsical defects. 

The afternoon school-hours are taken up with health-teaching. This 
includes a health talk once a week to each class, from Grades I. to VI., 
inclusive. At the beginning of each term I make out a preview of the 
work to be covered during that term. Copies of these are given to the 
teachers, who plan their poster-work and projects accordingly. In this 
way much valuable follow-up work is done and the subject further empha- 
sized to the pupils. 

In co-operation with the domestic-science teacher, as part of the 
routine for Grade VIII., I have held a series of classes in " Child Care." 
The work covered is very similar to that of the Little Mothers' League, 
with modifications and additions. The course involves some eight half- 
hour periods and is given once a week, the last half-hour of the domestic- 
science period. The girls are all most enthusiastic and a total of thirty- 
eight will be receiving their Little Mothers' League diploma at the 
completion of the course. 

Last spring, with the help and co-operation of the Women's Institute, 
a well-baby clinic was organized. It is held every third Friday in the 
Women's Institute hall and each doctor takes his turn in attending these 
clinics and advising the mother on the infant's feeding and general care. 
Up to date there are twenty-four babies registered. Due to the severity 
of the weather during the winter months it was necessary to cancel these 
clinics, but with the milder weather they are to be reopened. 

The Girl Guides of the city also are given two series of lectures, one 
towards the gaining of their sick-nurse badge; the other to the company 
as a whole, dealing with health in general and simple bandaging. The 
latter course is given in three half-hour periods at their regular weekly 
meeting. The former course is fairly extensive and requires about ten 
one-hour periods to cover the work required. These periods are held 
once a week after school. Through the kindness of Mrs. Wilmot, the 
Matron of the Kelowna Hospital, all practical work is given in the 
demonstration-room at the hospital. The course is limited to ten girls, 
all with a certain definite standing in the company. Already one class 
has completed the work successfully and another class is 0:1 its way to 
completion at the moment of writing. At the end of the course the girls 
are examined both in their theoretical and practical work by the Matron 
of the local hospital. 

At the fall fair last autumn, with the co-operation of Mrs. Grindon, 
the nurse in charge of the schools in the rural districts of Kelowna, a 
display was put on stressing certain phases of the public-health work 
here. One of these was the importance of hot lunches for the school- 
child. Due to an exceedingly active year, taken up with other matters 
of health, this scheme has not yet materialized, but, it is hoped, will 
receive more attention next year. The general public were most inter- 
ested in the health stall and asked innumerable questions. One thousand 



seven hundred books and pamphlets dealing with various subjects were 
also distributed during' the two days of the fair. 

Home-school visiting is quite a problem in this particular town. In 
the first place, the town is quite scattered and the streets long and wind- 
ing. Secondly, there is a notable lack of street-names at the corners; 
and, thirdly, to further add to everything, none of the houses are num- 
bered. However, by closely questioning the pupils and a very excellent 
map of the town, one is able to get about without running into too many 
blind roads and " parts unknown." 

I cannot close this article without paying tribute to the work done 
here by Miss Frances Lyne, whose place 1 took on her resignation at the 
beginning of the year. As one of the first School Nurses in Kelowna, she 
laid a perfectly splendid foundation for future public-health work, and 
due to her personality succeeded in winning the admiration of every one, 
from the parents down to the smallest child. 

The best wishes of us all go with Miss Lyne in her " new work." 

Edith W. Tisdall, R.N. 



PUBLIC HEALTH IN KAMLOOPS. 

Since coming to Kamloops in September, 1927, I have tried to steer 
my good ship " Health " by means of education, dividing it into five 
classes: (1) Education of the parents; (2) publicity; (3) education of 
the school-children ; (4) child-welfare; (5) social service. 

1. First we will think for a short time on what is being done by 
attempting to educate the parents. Free public-health lectures have been 
given. The subjects taken up were as follows: — 

(1.) Prenatal care of the expectant mother. 

(2. ) Care of mother and baby from the first month of life : (a) Impor- 
tance of well-baby clinics; (b) explanation of the digestive system and 
care of the human body; (c) great importance of breast-feeding. 

(3.) Care of regular weighing and annual inspection of preschool 
children; early attention to defects. Value of balanced diet (cod-liver 
oil, vitamins, etc.) ; also rest and sleep. 

(4.) Care of the school-child: (a) Value of annual medical inspec- 
tion; (6) value of regular weighing; (c) early attention to defects; 
(d) value of balanced diet (cod-liver oil, vitamins, etc.) ; (e;) value of 
immunization against diphtheria, smallpox, and other diseases; (f) isola- 
tion and immediate reporting to Public Health Officer when infectious 
diseases occur; (g) value of pasteurization of milk. 

2. Secondly, Ave will consider publicity. Articles that are written by 
" Hygia " from Otago Witness (New Zealand paper) are published regu- 
larly in the local paper. These articles are splendid and deal with the 
many difficulties that mothers come across with their new babies and 
pie-school children. " Hygia " represents the Plunket Society of New 
Zealand and was first started by Lady and Sir Truby King. My monthly 
and annual reports are always printed by the Sentinel. We have every 

26 



assistance from the owner and editor. They have given us many free 
advertisements in our health-work and have fully reported my lectures. 
They are splendid with their helpfulness. 

3. The third point is the education of the children. Here I feel, with 
almost concern at times, the great responsibility that is mine. I want 
to quote what I once heard Mr. Ira Dilworth, from Victoria, say: "We 
must come with great humbleness and wait with great patience, for we 
are on the threshold of the greatest of all mysteries, the human mind." 
And so it is, the child's mind is so rapidly developing, although I know 
parents and teachers often doubt the fact. Many people think that the 
weighing and measuring, and testing of Johnnie's eyes, and constantly 
sending him to wash his hands, neck, and ears (Oh, those ears; they are 
so difficult to keep pink and clean!) is the beginning and ending of the 
School Nurse's duties. Our work would surely be easy if such were the 
case. 



i 




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9m . A 




f$Jts #*♦. 



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Jmwt 






N* 



LITTLE MOTHERS' LEAGUE. 



Daily contact with the children makes life so worth while, just to 
see their merry faces and to hear their cheery greetings. This is the 
second year of the Junior Red Cross Society in the Lloyd George School. 
We now have seven groups formed. The children love the work. I try 
to attend one meeting a month to each group. The children have put on 
splendid little plays. It is always a joy to organize these groups at the 
beginning of their school-year. The children are so thrilled and feel so 
important when voting for their officers. Last year they did some splen- 
did work. They all worked so very hard for a bazaar which was held at 
the Lloyd George School on June 1st; each group was responsible for a 
stall. Mr. Bell, our principal, printed the name of each group and grade, 

27 






so that the different stalls were distinguished. They were prettily deco- 
rated with flowers and coloured paper. We sold afternoon tea and ice- 
cream, but no candy. The children decided at their meeting that no candy 
would be sold, so they were all happy on ice-cream. The stage was 
arranged like our well-baby clinic and was in charge of three older girls 
who were taking Little Mothers' League classes. One little girl actually 
asked a lady, who was looking round, " Did you breast-feed your baby? ?: 
When this lady told her she bad not, the little junior told her she could 
have, if she had tried, and gave her the pamphlet that is used in advising 
mothers how to restore their milk-supply. They did look so sweet in 
their caps and aprons. It was a huge success; we took in $165; The 
children made almost everything that was sold. We sent $128 to the 
Solarium, Vancouver island. We were specially interested in a little 
baby from Kamloops, who has since returned much benefited from her 
nine months' stay there. Altogether the children have collected .^243.45 
since October, 1928; that is including the bazaar, sale of Christmas seals, 
and subscriptions. 

The little mothers passed their test very well indeed, and we were 
most fortunate to have with us at the annual meeting Miss Nance Patrick, 
Director of the Plunket Nurses, New Zealand. She gave a short talk and 
presented the certificates and prizes. We were also happy to have with 
us Mrs. J. Fitzwater, President of the Red Cross Society, and Mrs. R. 
Johnstone, a very active social-service worker of that society. It was 
a wonderful day for the children. I think it just splendid to witness 
even the tiny juniors of Grade II. conducting their meetings. They are 
so serious and so amusing. 

Great interest is taken in the daily cleanliness inspection, which is 
done by the health captains of each row. These records are kept daily 
and each month 1 have the report of their groups, and the one with least 
defects wins the Health pennant, which says, " Health means success." 
They keep this for a month. 

At the beginning of the school term I sent out notices to all parents, 
asking permission to immunize their children against diphtheria. We 
immunized 40 per cent, of the children from the two public schools, also 
twenty-one preschool children. Daily I collect the names of absentees, 
parents are telephoned, and inquiries made. Home visits are then made 
if necessary; an average of forty visits is made a month. Parents are 
advised of defects and the necessity of having them attended to. Many 
tonsils, teeth, and defective visions have been looked after through the 
kindness of the Red Cross Society, City Council, Women's Institute, also 
doctors and dentists of this town. 

Hygiene classes were formed in the high school, both for boys and 
girls. Last year these were given after school-hours. The Girl Guides 
also have been given a course of talks on " Care of the Pre-school Child." 
They all passed their test. This year I examined the feet, without stock- 
ings, of all children from Grades I. to VII L I found many fallen arches 
and badly shaped feet, especially amongst the older girls, and many ill- 
fitting, badly shaped shoes with high heels. These children were given 

28 






special exercises and talks on the cave of feet and the proper footwear. 
I am giving each grade a health talk once a month. All children 10 per 
cent, and more underweight are weighed monthly. All children examined 
once a month for cleanliness. The work amongst the children is an ever- 
increasing joy. As a special treat I tell the little children Kipling's 
" Just So " stories. They just love them. 

4. Now I must dwell for a short time on the work that is done for 
the Red Cross Society. They organized some years ago a well-baby clinic, 
which is held twice a month. Last year we had an average of fourteen 
baby visits per clinic; total attendance, 207. Home visits to babies, 105; 
and 171 telephone calls for advice. 

Prenatal clinics were organized last year. I find it verv difficult to get 
in touch with the expectant mothers. At present they do not seem to 
understand the great importance of this work. It is only by means of 
education that we will be able to cut down the high maternal mortality of 
Canada. 

5. The social service. Work is mostly done by a very competent lady, 
Mrs. R. Johnstone, of the Red Cross Society. She is doing a wonderful 
work. There has been much unemployment this year, which has caused 
much sickness and distress. The Red Cross Society supplied 836 quarts 
of milk last year. Any families whom I consider needing more milk or 
cod-liver oil are always supplied by the Red Cross Society. I have made 
many social-service visits tin's year and have always had the ready assis- 
tance of the splendid society before named. Lately two preschool chil- 
dren suffering from deformities of the bone have come to my notice; also 
a child of school age who has subnormal mentality. Very soon I hope to 
be able to make arrangements to send these children to Vancouver and 
Victoria for special treatment. Public health is certainly divided into 
many sections and much sympathy and tact is needed. 

This fascinating work is still so new and is still in the pioneering 
stages, that we must be content with so little. When the public-health 
unit is an established and recognized necessity, then we missionaries of 
health will truly feel that something definite can be accomplished. 

At present there is too much to be done by the individual, and the day 
is all too short to do all that one wishes to do. 



Olive M. Garrood, R.N. 



CHILD-WELFARE WORK IX Till] COWICHAN DISTRICT. 

The growth and development of a district is somewhat similar- to that 
of a normal child. There are times, in the development of both, when 
their teacher is uncertain if her teachings will bring forth the required 
and looked-for result. 

Stretching the simile a degree or more, we might say that the 
Cowiehan District is merely in the difficult pre-school stage concerning 
public-health education. Public-health teachers have been giving their 
best efforts to the education of this district for many years, and we think 
we can safely sav that verv favourable results are forthcoming. 

29 




30 



In this short article I will compare present child-welfare conditions 
with those which existed a year ago, and also mention some of the child- 
welfare activities. 

Every Wednesday afternoon we have an " at home " for the infants 
and pre-schoolers. A nurse is on duty for the sole purpose of weighing 
the babies and instructing the mothers. There has been a steady but 
gradual increase in the number of babies attending these afternoons. 
Not only do the same mothers keep returning for further instruction, but 
we have, on the average, one new mother every two weeks. Our attendance 
has practically doubled in the last six months. 

It is through the co-operation of the mothers, in following our advice 
and advising others of our services, that we feel we are progressing. We 
also feel that to get the co-operation of all the mothers in our district is 
our big objective and we are working steadily towards that end. 

Our well-baby clinic, which is held once a month, has also had a 
steady increase in numbers. Seven to eight babies was the usual atten- 
dance less than a year ago. In our last clinic, held in February, twenty 
babies were weighed and examined. These numbers may seem small in 
comparison with other districts, but when we take the month as a whole, 
and can say that from forty to fifty babies are examined at the Health 
Centre, we feel very hopeful. 

Besides our monthly clinics in Duncan, we hold clinics in Bamberton, 
Shawnigan, and Hillcresf. These clinics are not held monthly, but only 
when we think that they are necessary. In the meantime we keep in 
touch with all the babies in the district bv visiting. 

The newest addition to our clinic list came as rather a surprise to 
us. A small note arrived from an outlying district, asking us if it would 
be convenient to make an infant- welfare visit on a certain afternoon. We 
complied with this request and arrived to find a house full of babies and 
mothers. This enterprising mother had created the nucleus of another 
well-baby clinic. And the clinic was well established, when they volun- 
tarily asked for our services regularly. 

Then, again, by the co-operation of the medical men of the district 
we are being continually put in touch with new babies. We have had 
numerous babies brought straight from the doctor's office to be weighed, 
and have learned that they have been advised to come regularly. We also 
procure a monthly list from the Court-house of all registered babies, and 
in this manner keep in touch with all the latest arrivals. 

In the fall fair of last year we had a booth in which child-welfare 
was featured. Much prominence was given to the well-baby clinic, to the 
preparation of formulas, and to the correct outfit of clothes for the baby. 
Two small tables were filled with foods, one containing nutritious foods, 
all equal in value to a glass of milk, the other containing harmful foods 
for young children. 

The interest shown in this display was full reward for any hard work 
if may have occasioned. It was no unusual sight to see small groups 
standing about earnestly discussing the food values or (he harmful foods 
for children. A nurse sat at a small table outside the booth, in readiness 

31 



to explain any of its contents, or to enter into conversation with any 
mother concerning her children, and to pass out as much literature as 
she thought would be appreciated. More contacts were made and more 
seeds sown on that day than can be estimated. 

Then, in addition to our infant-welfare work, we have recently been 
preparing to start a class in the " Management of the Preschool Child." 
A large meeting of young mothers has been called for March 3rd, when 
an outline of the different problems to be discussed will be presented to 
them. We are not sure that these new classes will be kindly received 
by all the mothers in the district, but we are doing our best to prove 
to them the necessity of understanding some of the problems of the pre- 
school age. These discussions will be carried on with reference to that 
useful book, received from the Department of Health, " Pa rents and the 
Pre-school Child," by William Blatz and Helen MeBott. The knowledge 
in this book is much too valuable to allow it to remain within its covers. 

We do not expect to clear up the difficulties that mothers are having 
with their pre-schoolers, but we do hope to make them aware of certain 
pitfalls. Thus prevention is the essence of our teaching. 

Anne Yates, R.N. 






NANAIMO SCHOOLS. 

The school population of Nanairno is approximately 1,250; 250 com- 
prise the high school and 1,000 the public school. The public school is 
divided into three ward schools and two eight-room central schools. 

The children are inspected once a month. They are weighed and 
measured twice a year. Eyes and ears are tested once a year, or more 
often if thought necessary in particular cases. Underweights are weighed 
every two months, or as nearly that as possible. 

In determining underweights we are using a new chart. Instead of 
a set weight for a certain age and height, this method gives a range of 
10 per cent, below and 20 per cent, above the hard-and-fast normal weight. 
It is a much more popular way than the old method and is proving as 
efficient. The 10 per cent, underweights are weeded out and it eliminates 
among the children and parents the feeling of the slightly below par. 

With regard to the medical examination, we are most unfortunate 
in this respect, in that the children are examined by a medical man only 
once during their school-life, and that upon entrance. The findings are 
entered upon their medical card, which is then duly signed by the School 
Medical Officer. Subsequent monthly inspections are made by the School 
Nurse and the data gathered from these inspections furnish material for 
the annual medical reports. We are still carrying on goitre treatment in 
the school under the direction of the School Medical Officer. The children 
are given a few drops of a sodium-iodide solution each morning for a 
period of six weeks. It is discontinued for three or four months, then 
treatment is begun again for another six-week period. There really has 
been an appreciable improvement in most cases. 

32 






After much delay we are again serving milk to the children at morn- 
ing recess. It is supplied at the nominal cost of 15 cents per child per 
week. The dairy from which we obtain our milk is, of course, one of the 
best, meeting all the requirements of Government and laboratory tests. 
Effort is made to interest underweights in this venture with a fair amount 
of success. 

NORAH E. ARMSTRONG, R.N. 






PORT ALBERNI. 

When I began this article of a partial review of the past year's 
health nursing here, I realized again the difficulty of giving a true impres- 
sion of one's own work; also of the added difficulty of being able to put 
one's finger on many results of teaching, good or bad. Sometimes, when 
you feel that your endeavours have met with no result whatever, you find 
later that your advice has been carried out to the letter. And in other 
cases, when you were hopeful of definite gain, you return to meet a 
baffling apathy or an old theory still alive. 

A tangible note of progress is in the medical examination of the 
school-children in the fall term, to be followed by one in the spring. 
Heretofore there was but an annual examination given in the late spring. 
Receiving classes are taken in the schools in September and February. 
A good percentage of the physical defects found are in these classes, show- 
ing clearly the need of a pre-school clinic, which has not been established 
here as yet. But a greater amount of interest is shown in the health 
reports sent home than I had noticed previously, and more attention is 
paid to the carrying-out of the advice given in them. 

There being a larger group of girls in Grade VIII. this year, it seemed 
advisable to have two classes of Little Mothers' League, which made two 
meetings each week. Most of the pupils were very satisfactory indeed 
to teach. 

The request of a Boy Scout group for classes in first aid indicated 
a. desire for more health knowledge, not only of curative but of preventive 
measures too. 

Bedside nursing is still a required part of the programme here. The 
service is used by two of the doctors as a method, at times, of keeping 
watch on the condition of patients and for demonstrating the correct 
methods of nursing and feeding, as well as for treatments. This service 
does give an entry into homes that would not be reached in any other 
way; also a backing that is sometimes needed. 

In the spring of last year the need of a new car for the health-work 
was felt. A drive was put on which realized the amount that, with the 
generous cheque from the Health Department, completely paid for the 
car. Those collecting said that they found it an easier task this year 
than last year. 

A very definite advance is in the interest in, and the attendance at, 
the well-baby clinics. By a vote of the City Council we are allowed the 
use of the light and convenient rooms in the new City Hall, giving the 

33 



service an added standing in the community. After the clinic's very qniet 
opening last March, with five babies in attendance, we have had the satis- 
faction of seeing it grow to its present size — of ninety-one infants on the 
registry and the usual attendance of twenty-four to twentv-seven at each 
meeting, in spite of inclement weather at times. The clinics are held fort- 
nightly, numbers coming to each one; some coming 10 to 14 miles and 
a few by boat. 

At the most recent clinic held the presiding physician remarked that 
the babies that had been coming regularly were splendid-looking infants, 
saying also that the mothers took a keen interest in the growth of their 
babies. Encouraging, too, was the statement made by a mother in a 
home, that her friend, who attended, told her that " Once she started 
taking her babe she wouldn't be able to stay awav." 

The progress has been very gradual ; nothing outstanding has been 
done, there is much that should be done, and when one reads of other 
districts' work we wonder if we can call this progress at all. 

Mary E. Grierson, R.N. 



PUBLICITY IN PUBLIC-HEALTH NURSING. 

Every nurse realizes how necessary the constant education of her 
public is to the progress of her work. Perhaps it may not be amiss to 
make a few suggestions regarding this very important and rather neglected 
branch of our work. 

There are several reasons why we need publicity. Probably the most 
important is in order to procure financial support for the budget. In 
order to do this it is necessary to enlighten the public in regard to the 
way in which the public-health programme is functioning. This enlarges 
still further into general education along health lines and the securing 
of intelligent interest in public health. 

For sound publicity there must be a sound knowledge of the local 
community. Different tactics are to be employed in the urban and rural 
areas. Then the various groups in the community have to be considered — 
the philanthropic groups, the social agencies. A keen appreciation of 
the psychology of individuals as well as groups is necessary. If it is 
possible to get a member of the Nursing Committee who is able to write 
well, such a person may very well be utilized, but the nurse must always 
keep in mind the fact that she has to supply the ideas and outline her 
plans. No one else can work up her publicity without much assistance. 

One of the first principles of publicity is to attract attention. Care 
must be taken to avoid too many figures and to use pictures liberally. 
On the other hand, pictures, photographs especially, are expensive. For 
variety, statistical tables and various types of graphs are invaluable. 
Simplicity and conciseness add to the effectiveness of articles. New and 
original slogans, with the addition of colour in various forms, will enhance 
the appearance of even so dry a thing as the annual report. 

34 




Another principle of publicity that must not be forgotten is the 
importance of regularity. A nursing organization that has at least one 
item a week appearing in some form or another is going to get new sup- 
porters regularly. It is always advisable for the nurse to make a direct 
contact with the local editors as the surest means of winning their 
co-operation. 

There are very many forms of publicity, too numerous to mention in 
any detail. Perhaps the following list will be sufficiently self-explanatory 
to be of nse and give many new ideas to the workers in the field. 

The forms of publicity include: (1) Reports, monthly and annual; 
(2) newspapers and magazines; (3) talks to groups, both directly, and 
indirectly by means of the radio; (4) exhibits, floats, booths, insignia; 
(5) posters, "pin" maps; ((>) stereoptic views and slides; (7) drama- 
tization in plays and parades; (8) through volunteers who will write up 
for publication their experiences with the nurse; (9) other volunteers 
who talk with their friends about their experiences with the nurse; (10) 
various individual conferences with key people in the community, prospec- 
tive committee members, leaders of clubs, etc.; (11) through pamphlets, 
books, circulars, bulletins, contests, letter-heads, debates. 

Few of us pay enough attention to the usefulness of the annual report. 
It should be a strong link between the community and the work of (he 
nursing service. It checks up the year's work of the organization. It is 
useful for comparison of the results in successive years. It shows the 
public what has been accomplished and serves to interest subscribers. It 
really forms the basis for the coming year's budget. Let us make our 
annual reports more living and useful and extend our work to embrace 
all forms of publicity. 

Margaret E. Kerr, K.N. 



PUBLIC HEALTH IX NANAIMO. 

The idea of prevention rather than cure is one that is very difficult 
for the public to realize, since doctors and nurses for centuries have been 
called only after " Sonny " has developed a pain or is " burning up." But 
when we find by the yearly reports that the child-welfare visits have been 
greatly increased, the average attendance at the weekly well-baby clinic 
is higher and the number of prenatal visits remains about the same, v 
although the number of confinements attended is considerably less, we 
see that public health is not at a standstill. We realize that more time 
is at the District Nurse's disposal for preventive work which was formally 
used for obstetrical and nursing care. Also when the reception on the 
initial baby visit to the home becomes quite friendly after the introduc- 
tion, or when it is cold on this visit but on the second an invitation to 
return is received, if is very gratifying. 

As much time as possible is given to infant-welfare and pre-school 
visits after the district nursing is done, which helps to fulfil the com- 

35 



munity needs. The ambition is to visit the child as early in life as pos- 
sible, obtain the mother's interest, and give her an invitation to the well- 
baby clinic, while probably announcing that tea is served. 

If the mother has other children it is often not convenient or pos- 
sible for her to attend. Then I visit the home as often as time permits, 
giving advice and answering questions as to diet and formation of regular 
habits. On the average the mother looks forward to these visits. The 
well-baby clinic is really a weighing-station with two nurses attending, 
the School Nurse and myself. As well as the child being weighed, advice 
is given to the mother, and on finding any defects the mother is advised 
to consult her physician. At Christmas each baby enrolled on the infant- 
welfare register received a Christmas card from the well-baby clinic. 
The mothers seem to appreciate this little human touch, as in many cases 
it was the first Christmas card their baby had received. 

The mother also brings her pre-school child and asks questions as to 
health habits and defects which are referred to the family physician. 
I hope that the day will come when Nanaimo will have a pre-school as 
well as the well-baby clinic. 

Although there is a great desire to reach the mother before the baby 
arrives, it is very difficult to make this contact. Nevertheless, the number 
of prenatal visits to mothers going to hospital or nursing homes is increas- 
ing, which shows that the mother not only has the nurse for her services 
at the time of childbirth and afterwards, but for the prenatal advice. 
Of course the obstetrical case gives the nurse a good contact into the 
home by making her a friend of the family. 

Home-nursing classes are held, which teach the mothers and young 
women to do simple nursing; but most important of all is the gaining in 
knowledge of the care of their own bodies and of the symptoms of com- 
municable diseases to prevent their spreading and the importance of 
prenatal care. 

At the Indian reservation a purely educational programme is carried 
on; but sickness seems to be the best contact, for then they consider the 
Public Health Nurse their friend who wishes to help them. Advice given 
at this time really concerns normal health habits, but it is better received 
when some one is feeling miserable. 

The Indian school-children receive the monthly inspection for cleanli- 
ness and are weighed, which is well received as in many cases it is the first 
experience on scales. At Christinas a toothbrush was placed in each 
child's parcel on the Christmas-tree and the children have responded 
wonderfully by trying to see how clean they can keep their teeth. 

The monthly well-baby clinic is well attended by the mothers and 
keen interest is taken in the gain in weight from one weighing to the 
next, as well as trying to follow instructions as to the care of the baby. 
Home visits are made, which instructs the mother in general hygiene. 

By patience and cheerful work we should soon find a drop in the 
infant and maternal mortality rate of our Province. 

Muriel Upsijali,, R.N. 
36 



THE DEVELOPMENT OF PUBLIC-HEALTH NURSING IN 
THE KELOWNA RURAL DISTRICTS. 

The beginning' of a New Year is always an opportune time to look 
back and review the work of the past, to note its weakness and its 
strength, and to plan for the future. 

History of the Kelowna Health Unit. — The nucleus of the Kelowna 
Health Unit originated in 1920, when Doctor G. A. Ootmar, Bacteriologist, 
was appointed to the charge of the new Central Laboratory at Kelowna 
and later as whole-time District Medical Health Officer. In September, 
1927, the school-work of twelve rural schools was also added to his work. 
It was not until March, 1928, that a Provincial Health Nurse was 
appointed to co-operate with the District Medical Health Officer, and to 
organize and develop all public-health nursing activities in an area of 
some 100 square miles, embracing twelve rural schools with a school 
population of some 550 school-children. 

In September, 1928, the City of Kelowna engaged a School Nurse for 
its 900 school-children. In July, 1929, Dr. Ootmar was asked to become 
Medical Health Officer and Sanitary Inspector for the City of Kelowna 
also, and in September, 1929, an Assistant Technician was appointed to 
the Central Laboratory. Thus in January, 1930, we have in Kelowna 
City and rural districts a health unit covering public-health activities in 
all its phases in the city and rural districts. 

TJw Keloivna Rural Schools Health Association. — To centralize the 
school-work of the twelve Rural School Boards in the scattered rural 
districts, a representative committee of school trustees and members of 
local Women's Institutes was organized under the name of " The Kelowna 
Rural Schools Health Association." This voluntary committee receives 
reports from the Rural Health Nurse, assesses the school population on a 
pro rata basis to help to pay for the service, pays all expenses of trans- 
portation, etc., and at its own suggestion co-operated with the Provincial 
Health Officer to provide half the cost of a new Ford coach for the rural 
nursing service. 

So much for the machinery of local organization; we will now con- 
sider the development of the work in the rural districts during the past 
twenty-two months. 

Campaign for Active Immunization against Diphtheria. — My first 
duty in 1928 was to help organize a campaign for active immunization 
against diphtheria in a rural district where diphtheria was epidemic at 
the time. This was most difficult because of the public indifference, lack 
of knowledge, and often definite antagonism to such a new idea. How- 
ever, at the close of the campaign 300 throat-swabs had been taken and 
examined, 51 carriers found, 136 children Schiek- tested, 11 clinics held, 
and 88 inoculations of diphtheria toxoid given. The epidemic was checked. 

It is most interesting to note as a sign of progress that in our recent 
campaign for active immunization against scarlet fever (of which I will 
speak more fully later) there was a splendid response from the very same 
people who were indifferent and antagonistic two years ago. We are 

37 



hoping to utilize this new attitude of mind to organize another campaign 
for active immunization against diphtheria in the spring. 

Health Education. — Health-teaching has been emphasized by the 
distribution of many pamphlets in clinics, schools, homes, meetings, and 
at the fall fairs; some 5,180 pamphlets have been distributed in the rural 
districts alone. Our thanks are due to the Metropolitan Life Insurance 
Company for the excellent literature it forwards free on request, also to 
Miss Elizabeth Breeze, who gave thirty-two sources of supply in the course 
in health education at the Victoria Summer School for Teachers. (This 
inspiring and interesting course would be most valuable to all school 
nurses as well as to teachers.) 

The distribution of health literature has-been followed up by the 
usual routine health-teaching in the schools, and by some twenty-seven 
addresses given by the Rural Health Nurse at different times to meetings 
of Women's Institutes, parents, and ratepayers on health subjects and 
public-health organization. 

Health Booths. — Two health booths planned by the Health Nurses at 
the Kelowna Fall Fairs, emphasized with posters, literature, and projects 
the value of active immunization against diphtheria, vaccination against 
smallpox, and free chest examination, together with nutrition and dental 
projects. Much information was given by the Health Nurses on duty and 
many pamphlets given away. In connection with the fall fairs the Dis- 
trict Medical Health Officer also put on most interesting projects to 
demonstrate the sources of typhoid and diphtheria infections and water 
and milk contamination. 

Development of Free Clinics in the Rural Districts. — The development 
of free clinics has been an interesting phase of the rural health activities. 

There are now four well-baby. and pre-school clinics operating in four 
different districts under the auspices of the different Women's Institutes 
and clubs, in charge of the District Medical Health Officer and Provincial 
Health Nurse. 

Thirty well-baby and pre-school clinics have been held, with a total 
of 167 attendances. The names of 137 infants and pre-school children 
have been listed on the child-welfare register and we have come into touch 
with eighty-two new infants and preschool children in our recent cam- 
paign for active immunization against scarlet fever. 

Other free clinics include: 5 chest clinics (Dr. A. S. Lamb, Gov- 
ernment Chest Specialist), 39 attendances; 1 eye, ear, nose, and throat 
(Dr. McNamee, Specialist, Kamloopsi, 12 attendances; G Schick tests 
(Dr. G. Ootmar, M.H.O.), 1G1 attendances; active immunization against 
diphtheria (Dr. G. Ootmar). 113 attendances ; 77 clinics — Dick test (Dr. G. 
Ootmar, M.H.O.), 450 school-children, 106 preschool and infants; active 
immunization against scarlet fever inoculations, 1,403 school-children, 535 
pre-school children and infants. 

Clinic work in the scattered rural districts entails much organizing 
on the part of the Health Nurse, telephoning, book-keeping, and letter- 
writing, but the results are worth the trouble. In the 125 clinics listed 
above there has been nearly 3,000 attendances of school-children and pre- 

38 



school children. We have come into intimate contact with these children 
and their parents, gradually educating their minds to the value of the 
gospel of prevention, gaining their confidence, and laying a foundation for 
the development of the principles both of the prevention of disease and 
the promotion of positive health, which so many people do not understand 
and therefore resist. 

The first result of this contact was apparent in the result of our cam- 
paign for active immunization against scarlet fever, of which I will now 
speak more fully. 

Campaign for Active Immunization against Scarlet Fever. — In 
November, 102!), a scarlet-fever epidemic of a mild type was prevalent 
in a city some 40 miles south of Kelowna; schools were closed and the 
epidemic was spreading into the surrounding districts. Kelowna and 
districts as central points in the valley were daily in danger of infection. 
A campaign for active immunization against scarlet fever was organized 
in Kelowna and the surrounding districts. 

The District Medical Health Officer and Rural Health Nurse 
addressed ten gatherings of parents in the different rural districts. The 
Health Nurse explained in simple terms the theory of active and passive 
immunity and the real meaning of " resistance Vl to disease; the Health 
Officer, the value of active immunization and the present need of protec- 
tion. Some 1,800 pamphlets written by the Health Officer, to be read and 
signed by parents, were distributed at the meetings and in the schools, 
the Health Nurse explaining the contents of the pamphlets to the teachers 
and older children. This pamphlet was also published in the local paper. 

The results were most encouraging; very many parents gave their 
consent, and in spite of the fact that almost immediately every home 
received a warning pamphlet from the Canadian Anti-Vivisection Society, 
Victoria Branch, denouncing inoculation and the Dick test, and several 
letters were published in the local paper by the same society, to date 
(January 31st, 1930), in the rural districts, 77 free clinics have been held, 
1,408 inoculations have been given to school-children, and 535 inoculations 
to pre-sehool children and infants. 

Jn the City of Kelowna 30 free clinics have been held, 1,754 inocula- 
tions given to school-children, and 191 to pie-school children. Very many 
children have also been immunized by private physicians. 

There was a total of nine cases of mild scarlet fever in the rural dis- 
tricts and twenty cases in the City of Kelowna; no new cases have been 
reported, and we hope there will be no more now, so many of our children 
have been actively immunized. More than 100 cases were reported from 
the city and district where the epidemic originated. 

School-worlc. — Here I must pause to pay a tribute to our school- 
teachers and School Boards, who, with one exception, have co-operated so 
heartily in our health-work among Hie children. Even in the schools 
where the Health Nurse was not wanted at first, there is now a cordial 
feeling of co-operation. A water system was laid on in one school and 
paper towels put into two other schools. School trustees would do much 
more had they funds to expend. 

39 



It would take too long in an article of this kind to speak in detail of 
the work among the rural school-children, the defects corrected, nutrition 
improved, and health education given. Of the epidemics we have tried 
to stop, sometimes with success, sometimes not so successfully ! How 
much we should like to see ' k active immunization " against the " common 
cold,'" measles, mumps, and whooping-cough, etc. ! 

Prenatal Hygiene. — A branch of the work which we hope to develop 
is prenatal hygiene. In addition to home-visiting, we should much like 
to add this phase of the work (with the consent of local physicians) to 
our free clinic work in the rural districts. 

This is, however, impossible, unless it can be done with the very cor- 
dial assent and, indeed, with the wish of our local physicians, under whose 
care these patients have placed themselves and to whom all clinic findings 
would be sent. 

Development in the Western Portion of the District .--An interesting 
development in Westbank has taken place in the western portion of my 
district — isolated by night and winter weather from medical and hospital 
care by the Okanagan Lake. 

We felt that a Public Health Nurse should be placed here, one who 
would live in the locality and do public-health nursing with bedside care, 
caring also for the Indians. I made a survey of the possibilities of this 
and the adjoining district and placed it before the Provincial Health 
Officer. The local Women's Institute communicated with him and with 
Miss Smellie, Chief Superintendent of the Victorian Order of Nurses, 
with the happy result that with the monetary assistance of the Provincial 
Department of Health, the Federal Department for Indian Affairs, and 
the Victorian Order of Nurses, a Victorian Order Nurse was placed there 
at the beginning of the year. We are so glad to welcome another Public 
Health Nurse in the valley and trust that soon the whole Okanagan will 
be linked up in a health service from Armstrong to the American border. 

It would not be fitting to conclude an article on the development of 
public-health activities in the Kelowna District without especial reference 
to the splendid work accomplished during the last fifteen months in the 
Kelowna City schools by Miss Frances Lyne, R.N., who recently left the 
service to be married. 

Kelowna City was fortunate in its first School Nurse, for Miss Lyne's 
charm of personality and executive ability has had much to do with the 
cordial attitude of Kelowna City to the health programme. 

Her school dental clinic has been a great success; her splendid health- 
teaching programme, both in the schools and to Girl Guide classes, much 
appreciated; and the Kelowna well-baby clinic is doing excellent work. 

As Rural Health Nurse I am not in a position to speak in detail of 
her work in the city, but I would like to quote from the Chairman of the 
Board of School Trustees, given at the annual meeting of the City 
Council: "The health of the pupils in the school was excellent; in fact, 
away above the average. Although there had been epidemics all around, 
it had been possible to avert them from the schools, for which he gave 
credit to Miss Lyne, ' the School Nurse.' " 

40 







Appreciation of Health Unit. — At the same meeting* one of the Alder- 
men said : " The most progressive step taken in health was the formation 
of the full-time health unit. ... A splendid amount of work had been 
accomplished in a short time and before long the city and district, he 
believed, would possess an enviable health record." 

From the rural districts comes a letter of appreciation from a school 
principal to the Board of School Trustees : " I have been much interested 
in the work of the Medical Officer of Health and of the Provincial Health 
Nurse as it affects this school. Both these officers approach their work 
with enthusiasm and carry it out with painstaking regularity and 
thoroughness." 

Summary .--To sum up: What is the real advance worth while which 
has been made during the past two years? I think it is that somewhat 
intangible asset, the slowly changing attitude of the mind of the general 
public towards our teaching, a clearer understanding of our aims, and 
as a result, a greater willingness to co-operate in public-health activities. 

What are the signs which denote this change of heart? First, the 
excellent response of the parents to the immunization campaign against 
scarlet fever; second, the more frequent reporting of communicable dis- 
eases and suspicious symptoms by parents to the Health Nurse, with 
requests for investigation and advice; third, the coming of foreign 
mothers, Japanese, Italians, and Germans, to our clinics. The children 
are in our schools, the parents are beginning to trust us, and we, too, are 
beginning to understand their attitude better. In short, the general 
public are just beginning to look upon the health authorities as their 
friends, a protection to their children and homes, instead of " policemen " 
curtailing the " liberty of the subject." 

May it not be that the Public Health Service is also doing its part, 
by friendly and helpful contact with our immigrant citizens especially — - 
(of whom we have many in the Okanagan valley), to build up in Canada 
a nation of people with ideals of healthy living and good citizenship! 

If this is true, even in a very small degree, our work is well worth 
while. 

Anne F. Grindon, R.N. 




UNIVERSITY HEALTH SERVICES OF CANADA. 

A Public Health Nurse was appointed at the University of British 
Columbia in WY11 on the recommendation of the Provincial Officer of 
Health, following an outbreak of measles which involved some hundreds 
of students, with consequent loss of time and money to the University as 
a whole, to say nothing of the resultant physical after-effects inherited 
by all those individuals who contracted the disease. 

41 



The Department over which the nurse presides is known as the 
University Health Service, with temporary offices and first-aid room in 
the Auditorium Building. 

In passing - , special mention should be made of the furnishings and 
equipment which were provided as the valedictory gift of the 1927 gradu- 
ating class. The students responsible deserve the warmest thanks and 
appreciation of all present University people, since the only people who 
could not benefit from the useful gift were the givers thereof. 

The duties of the nurse, as outlined at the beginning, embodied a 
complete prevention programme (no nursing) along any lines found to 
be workable at the University and included one or more courses of health- 
education lectures each term. These lectures were to be considered 
voluntary and non-credit. In addition to the University and Endowment 
Lands, the health-work and inspection of the University Hill School were 
also a part of the nurse's plan. This latter has been done in an honorary 
capacity to date, the work for some obscure reason receiving no recog- 
nition from the Department of Education so far, although the number of 
pupils has increased from 30 to 100 in two years. 

During the latter part of 1928 the medical service was added to the 
work of the University Health Service. 

The actual medical physical examinations are done during the months 
of October and November. The work consists in the medical examination 
of all first-year students entering the University and recording the 
physical defects found. This medical examination is compulsory, and 
from now on a student failing to present himself for the examination on 
the date and time appointed is liable to be suspended by the President of 
the University. At the present time the examinations are conducted at 
the Vancouver General Hospital, with Dr. IT. White and Dr. Monica 
Saunders as examiners. 

The University Health Service renders aid in all cases of sudden 
illness or accident which occur on the campus. This work includes trans- 
portation and is made possible by the financial support of the car by the 
Provincial Board of Health. The necessity of a car will be understood 
when it is known that eighty such transportations were provided during 
the 1928-29 session. It will be seen readily that in the case of communi- 
cable disease the minimum amount of contact is thus encountered between 
the University and the student's home. 

Notwithstanding the foregoing, the chief function of the University 
Health Service Department is to teach health education and prevention 
of disease, and every Public Health Nurse knows how difficult it is to do 
more than keep in touch with all these phases. At the University, we are, 
however, trying very hard to make a specialty of vaccination against 
smallpox, and are having many interesting experiences and difficulties, 
our chief difficulty being the clause in the " Health Act " which permits 
people to take out what is known as a conscientious-objection affidavit. 
This clause is taken advantage of by people who are not in fact conscien- 
tious objectors, who don't even know the meaning of the term when ques- 

42 



tioned or what it involves. They frankly wish to escape the temporary 
inconvenience caused by vaccination. 

As the result of a questionnaire sent to first- and second-year stu- 
dents, University of British Columbia students to the number of 399 dur- 
ing the 1928-29 session were vaccinated at the University Health Service. 
Others were done bv their familv physician, as this service is onlv given 
by the University to those who, for some reason, cannot be done by a 
private physician. Of those students vaccinated, ninety-eight had never 
previously been vaccinated and gave some surprisingly simple reasons 
why, among them being: u When it was being done I was going in for 
sports or to a dance " ; or, most simple of all : My arms were dirty and 
the next day the vaccination was not being done." Still others claimed 
that in the public school they merely stated their personal objections and 
were exempted. It is astonishing that such a group scattered about the 
the Province, many of them in the large cities, should have been able to 
pass through our schools unvaccinated, for the reasons given. 

Following are some particulars covering the University Health Ser- 
vices of four other Provinces and is the result of a study made during the 
summer by the writer. It will be noted that the University of British 
Columbia is the only University in Canada which has a Public Health 
Nurse on its staff, and that sickness is provided for in only two of the 
Universities under survey, the expenditure being covered in each case by 
a yearly tax of $5 imposed upon each student. No responsibility is 
accepted by the University authorities of McGill or Toronto Universities 
for any sickness which may occur among the student body. 

Montreal. 

Health Laics. — Enforces all citizens to be vaccinated. 

McGill University. — Will not admit students who have not been 
recently and successfully vaccinated; students may be vaccinated in the 
Medical Department. 

Medical Service. — Department functions throughout the year. Com- 
pulsory medical examination which is enforced; is done more than once 
each year if Medical Director orders such. No follow-up; no nurses; 
Medical Department attends to first-aid injuries and in case of sickness 
one week's hospitalization is allowed. A dispensary functions for the 
use of students. 

Physical Education. — Compulsory for regular students, two periods 
each week being devoted to it. 

Health Education. — In relation to prevention has not yet been con- 
sidered, although its importance is recognized by the University medical 
authorities. 

Toronto. 

Health Lairs. — Enforces all citizens to be vaccinated. 

'Toronto University. — By order of the Board of Governors, every stu- 
dent for admission must submit a certificate of successful vaccination or 
agree to submit such certificate within ten days after opening of session. 
Students may be vaccinated at the University Health Service. 

43 



Medical Service. — Functions throughout the year. Medical examina- 
tion is compulsory for all regular students; no follow-up or nursing is 
given. First-aid treatment is given by the Medical Director or one of his 
assistants. The University accepts no responsibility in case of sickness. 

Medical Students. — Have a sick fund arranged and administered by 
themselves to meet requirements in case of sickness of any of their own 
group. 

Physical Education. — Is compulsory and non-credit. Lectures on 
first aid and hygiene are given to first-year medical and forestry students. 

Health Education. — A series of three lectures are given called 
" Health Talks," based on defects revealed at medical examination of 
students. The time is taken from the Physical Education classes and 
credits given for attendance. 

Health education in relation to prevention is much desired by certain 
of the medical authorities responsible for the health of the University. 

Manitoba. 

Health Laws. — In relation to vaccination could not be ascertained. 

Manitoha University. — Requires that entering students who have not 
been recently and successfully vaccinated must have this done before 
entering College (page 28 of the Calendar of the Manitoba Agricultural 
College). 

Medical Service and Health Service. — Students in all years must 
submit to a .yearly medical examination. A fee of $5 is collected yearly 
from all students to defray the expenses of the medical examination and 
of sickness; hospitalization of two weeks is given. The College has in 
residence a qualified dietitian, a qualified physical instructor, and two 
trained nurses ; these people are responsible for the health of the students 
and for reducing the loss through sickness, of the education offered. 

College Hospital. — In both men's and women's residences is small but 
well-equipped hospital of sixteen beds with trained nurses in charge 
(thirty-six beds in all). The nurse has the right to say when a student 
requires treatment in the hospital, or to see the physician. 

Physical Education. — Compulsory and non-credit, two periods weekly. 
Residences. — Accommodate over GOO men and women students and are 
equipped with splendid swimming-tanks and gymnasiums. 

Alberta. 

Health Laics. — Requires citizens to be vaccinated and reserve the 
right to enforce vaccination should the occasion arise. 

University. — Nothing written into the Medical Service rules about 
vaccination. 

Medical Service. — Compulsory medical examination for all entering 
students; in case of sickness thirty days' hospitalization allowed. A fee 
of |5 is collected by the Biirsar at time of registration, which covers 
expense of this service. No follow-up on defects; it is up to the student 
when advised. 

44 




College Hospital. — Of sixteen beds; is in charge of a lady, who is 
an Edinburgh M.T). and a graduate nurse ; but if nursing is really involved 
the student is transferred to the University Hospital. 
Physical Education. — Compulsory and non-credit. 
Note. — There seemed to be a lack of interest on the question of vac- 
cination in the Medical Department. 

Celia A. Lucas, R.N., 

University of B.C. 



PUBLIC-HEALTH NURSING, MAPLE RIDGE AND MISSION 

MUNICIPALITIES. 

When I entered the University of British Columbia in September, 
1928, for the course in public-health nursing, I was quite sure that at the 
end of the University year I should return to hospital nursing or to 
private duty. By the end of the course I was converted to a public- 
health point of view. Now, after six months as School Nurse in the 
Maple Ridge and Mission Districts, I am quite convinced that the preven- 
tive end of nursing is even more interesting and fascinating than is the 
curative end of the work. 

Public-health nursing, or, rather, school nursing, began in the above- 
mentioned districts in September, 192!). The nurse was appointed by the 
two School Boards through the Provincial Health Officer. The Women's 
Institutes of the two districts were, however, largely responsible for 
arousing the interest of the people of the district in the work. Therefore, 
to them must go much of the credit for the ultimate appointment of a 
nurse and the beginning of the work. 

The two districts extend from Port Hammond along the Eraser Valley 
to Hatzic Island, Ruskin being the divisional point. 

There are nine grade schools in the Maple Ridge District, with a 
total of twenty-eight rooms and total enrolment of approximately 1,050 
pupils. In addition, there is a central high school at Haney with six 
rooms. 

The Mission District has nine schools, including the high school, 
which is situated at Mission City. These schools have a total of twenty- 
two rooms and total enrolment of approximately (595 pupils, about 24.2 
per cent, of these pupils being Japanese, the bulk being found in the 
lower grades, only two attending the high school. 

The Maple Ridge District has a larger percentage of Japanese, one 
school reporting 51 per cent, in one of the lower grades; the average 
throughout the schools is more than 30 per cent. 

My time is equally divided between the two districts. September and 
October were spent in Maple Ridge; November and December in Mission; 
since the New Year alternating each month. In the case of an epidemic 
in either district the nurse may remain a longer time, the time to be 
adjusted before the end of the year. Because of an outbreak of diphtheria 
in the Hammond School early in January, I remained in that district until 
the end of the first week in February. An epidemic of colds and sore 

45 



V 



throats in the district at the same time worked havoc with the attendance 
and made much home-visiting and swabbing of throats necessary. 

Those acquainted with public-health work will readily see the disad- 
vantages of having to divide one's time between two districts, each of 
which is sufficiently large to keep a nurse going full time, if the work 
is to be carried on successfully. Due to the diphtheria outbreak one child 
lost his life and several others are to a greater or lesser extent perma- 
nently affected. This and all the inconvenience and unhappiness involved 
for at least three or four of the five families whom it was necessary to 
quarantine could have been prevented had the nurse been on duty in the 
district during the months of November and December. In home-visiting 
three days after the schools opened in January, three families were found 
to have suspicious symptoms (one, a large family, admitted having had 
suspicious symptoms in the house for seven or eight weeks). Two more 
positive throats were found in the school — one a member of the above- 
mentioned family. Prompt action was taken by the local Medical Health 
Officer and further spread was prevented. 

This was an unfortunate occurrence, as such outbreaks always are. 
Nevertheless, it should and will, 1 believe, help our cause. There are still 
those who seem not to realize their responsibility or duty towards others 
where infectious disease is concerned, and who will "cover up" if possible. 
The Medical Health Officer, working alone, with his private practice to 
attend to besides, certainly cannot be expected to discover all cases of 
infectious disease before they become a source of danger to the community. 

Measles were present in the Whonnock and Kuskin Districts during 
the summer holidays, chiefly, if not entirely, amongst the Japanese. By 
the end of the second week after schools opened the disease was in full 
swing. Efforts to stop the spread without closing the schools gave unsat- 
isfactory results. This was due, largely, to the fact that the Japanese 
schools are without medical supervision and contacts excluded from our 
schools continued to go to the Japanese schools, in spite of instructions to 
remain at home. On the whole, I have found the Japanese people willing 
and anxious to co-operate. In many cases their failure to do so was, 
I believe, due to lack of clear understanding. 

The health-teaching in the schools is gratifying in the keen interest 
shown by the pupils. Progress in this work is delayed, though, by lack 
of proper facilities, such as basins, individual drinking-cups, towels, etc., 
especially in the rural schools. One feels sometimes that teaching of 
proper health habits should begin with the parents and the members of 
the School Boards. After all, without their full co-operation any amount 
of health talks, health stories, crusades, and so on, cannot give the best 
possible results. However, Avhen one realizes that School Boards have 
others than themselves and the nurse to please, one understands why 
these things are sometimes slow in coming. 

Many of the teachers show appreciation of the need and value of 
health-teaching in the curriculum. There are some very fine posters in 
some of the schools, some of which were prepared by the pupils. 

The scales are a great source of interest. Most of the children seem 

46 



to be very anxious that their room or school shall be the one to get the 
health banner for the highest percentage of red stars. Many of those 
who were 10 per cent, or more underweight in September are now almost 
normal weight. 

Defects are slowly becoming corrected, too slowly ; but thanks to our 
instructors at the University of British Columbia, we realize that we need 
not expect immediate action in very many of these cases, so are helped to 
be patient. Even a few pairs of glasses where they were needed most and 
a few first molars saved and defective tonsils removed makes one feel that 
the work is really worth while. 

Easter and summer vacation time should see many more of these 
defects attended to: 

I regret that, as yet, there is not a nursing committee formed in 
either district. Until each district has a full-time nurse very little of 
the other branches of public-health work can be carried out. Under the 
present system, if an office were provided and equipped, it would be used 
for only six months in the year. The School Board is my only committee 
in each district. The service is purely on trial for the first year. There 
are no commitments past that time, but I believe it has been decided that 
the work is to be continued. 

Both districts have splendid live organizations in the Women's Insti- 
tutes, and I hope that one or two years from now will find the various 
branches — infant-welfare, prenatal, T.B. work, etc. — well developed. 
These branches are, of course, not entirely neglected, but as yet T have 
not found time to give them much attention. 1 was employed primarily 
as School Nurse, and with so many schools do not have to look far for 
work. 

Two seriously underweight children visited Dr. Lamb's clinic at New 
Westminster and one teacher visited the clinic at Abbotsford. All were 
negative, I am glad to report. One Japanese family with a tuberculous 
mother returned to Japan. 

There is considerable misunderstanding as to where the work of the 
Public Health Nurse should begin and where it should end, but I have 
been pleasantly surprised by the knowledge of our work, aims, and ideals 
shown by the great majority in my districts. One parent did send word 
to a teacher during my first month in the district that I might look into 
her child's mouth, but must not pull any teeth. On another occasion a 
'teen-age girl whom I inspected at school, later in the day, told a local 
merchant that she understood me to say she should have her face lifted. 
However, I think it is generally understood now that the Public Health 
Nurse is neither dentist, beauty specialist, nor family doctor. 

At the Whonnock and Haney Fairs in September Metropolitan Life 
and Department of Health literature was distributed. In addition, at the 
Haney Fair a " creche " and mothers' rest-room were arranged with the 
help of some of the Women's Institute members. In spite of unfavour- 
able weather which kept many mothers at home, at least two or three 
babies slept soundly and comfortably while their mothers were free to 
see the exhibits. 

47 



Home-nursing classes are being given to one room of girls in the 
Haney High School. They are very enthusiastic about the course. The 
Boys' Science Club of the High School was addressed on " Progress in 
Public Health." Two rooms in the Mission District asked for a lesson 
on vitamins. They were anxious to know more about these mysterious 
constituents of food and apparently appreciated what information I was 
able to give them. 

The Women's Institutes and Parent-Teachers' Association were 
addressed. I am trying to tell them of the possibilities of the service in 
the hopes that ere long another nurse will be provided and the various 
clinics, etc., will be established. On two occasions Dr. Young's and 
Dr. Berman's annual reports were read and discussed. The main idea 
was to create better knowledge of what a full-time health unit means to 
a district. 

And so the work goes on with something new and interesting to see 
or do every day. From Hammond with its large cedar-mill along the 
Fraser River to the beautiful Ilatzic Valley, which is noted as the home 
of the Cuthbert raspberry ; back through the woods to Stave Falls, the 
location of the huge B.C.E.R. power plant, which supplies much of the 
power for Vancouver and surrounding districts; then down to the new 
and wonderful developments of the same plant near Ruskin — well, I ask 
you, who would not prefer work which takes one over such roads sur- 
rounded by such scenery with the majestic mountains in the background, 
and in a new Ford coach into the bargain? Who would not prefer that 
to standing all day in an operating-room with a temperature of 90° or 
listening to the groans of sick people? 

Then last, but not least, there are the encouraging letters from the 
Department of Health at Victoria, which always seem to arrive when 
they are needed most to help one over the " rough spots," which are, 
after all, surprisingly few. 

Hetty E. Fawcett, R.N. 



PERSONALS. 



The Provincial Public Health Nurses were well represented at the 
International Congress of Nurses in Montreal, July, 1920. Mrs. C. A. 
Lucas, Miss M. Claxton, Miss M. Kerr, and Miss O. Gar-rood were 
registered. 

Miss M. Claxton resigned as Supervisor of Cowichan Health Centre 
in June. After attending the I.C.N, in Montreal, she went home to 
England for a visit. Miss Blanche Mitchell was appointed to succeed her. 

Miss Kathleen Snowden, formerly Public Health Nurse at Keremeos, 
resigned in June to be married, and is now living in West Summerland. 

Miss Mary Henderson, B.A.Sc. '29, was appointed to the staff of the 
Saanich Health Centre in September. 

Miss Anne Yates, B.A.Sc. '28, joined the staff of the Cowichan Health 
Centre. 

48 




Miss Muriel Upshall, B.A.Sc. '29, succeeded Miss Verna Beckley as 
District Nurse in Nanaiino last June. 

Miss Edith Tisdall, B.A.Sc. '29, was appointed to the Keremeos Dis- 
trict to succeed Miss Snowden last June. In December she was trans- 
ferred to Kelowna to take the position of School Nurse. 

Miss Margaret Kerr, B.A.Sc. '26, who received her M.A. from Colum- 
bia University, New York, last year, was appointed as Instructor in 
Public Health Nursing at the University of British Columbia in October. 

Mrs. B. Thomson (Bertha Thorsteinson, C.P.H. '24) is now Public 
Health Nurse at Keremeos. 

Miss Frances Lyne, B.A.Sc. '27, resigned from her position as School 
Nurse at Kelowna in January. She was married to T. R. Hobart, of 
Silverton, Oregon, In February. 

Miss H. E. Fawcett, C.P.H. '29, was appointed Public Health Nurse ^ 
for the Municipalities of Maple Ridge and Mission last September. 

Miss Flora McKechnie, B.A.Sc. '28, was forced to resign from the 
staff of the Cowichan Health Centre for personal reasons, her place being- 
taken by Miss A. Roberts, from England. 

Miss Olive Ings, C.P.H. '29, was appointed Public Health Nurse, 
inaugurating a new service at Westbank, in January of this year. 

Miss G. M. Kitteringhani has taken Miss M. Twiddy's place at Oliver. 

Miss A. Roberts has recently gone up into the Peace River country to 
inaugurate a public-health nursing service there. 



VICTORIA, B.C. : 
Printed by Charles F. Baxfiei.d, Printer to the King's Most Excellent Majesty. 

10:30. 



400-4:!0-!H)<>;> 

49 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 MARCH, 1931. No. 8 



FOREWORD. 

IT HAS BEEN the custom to write a few general remarks in reference 
to the work that is being carried on by the Public Health Nurses. 
This year, in reading over the articles presented by the nurses, T think an 
excerpt from Miss Twiddy's paper will do Tor the foreword. After dis- 
cussing various phases of the work, Miss Twiddy concludes as follows: — 

"Experience is a good teacher. If may be an expensive and slow 
method of obtaining knowledge, but one learns many interesting lessons 
as a Public Health Nurse. It is surprising from whom and under what 
circumstances these lessons come in the school of experience. Day after 
day and week after week knowledge accumulates. Wisdom may linger 
when it conies to make use of the lessons, but if the Public Health Nurse 
maintains her sense of humour she will have gone far towards success. 
She must not be discouraged by disappointments, but look for the silver 
linings that are always to be found somewhere, linn in her conviction 
that eventually will dawn (hat day so well described by Lord Tennyson :- 

" 'All diseases quenched by science, no man halt, or deaf or blind. 
Stronger ever born of weaker, lustier body, larger mind.' " 



TABLE OF CONTENTS. 

Page. 

Progress. Editorial 3 

Teaching the Teacher to Teach. By M. E. Kerr, R.N 3 

Stock-taking. By Mabel F. Gray, K.N. __ 4 

Opening up a New Service in the Peace River. By A. M. Roberts, 

R.N 5 

Westbank, Peachland, and Indian Reservation. By Hilda E. 

Barton, R.N 6 

French Creek and District. By Margaret M. Griffin, R.N. 7 

The Saanich Health Centre. Bv Esther S. Naden, R.N 9 

University Hill School. By C. A. Lucas, R.N 10 

Chicken-pox. By Elizabeth Lowther, R.N 12 

Then and Now. By M. A. Twiddy, R.N _ 13 

Ladysmith. By J. Worthington, R.N 14 

Public-health Nursing in Montreal and Saanich. By Audrey B. 

Payne, R.N 15 

Keremeos, Cawston, Upper and Lower Similkameex Reserve. By 

B. Thomson, R.N.... 17 

A Dental Clinic in a Rural District. Bv A Lav Worker ID 

Active Immunization against Diphtheria. By Edith W. Tisdall, 

R.N 23 

Public-health Nursing in Fernie. Bv Winifred Seymour, R.N 24 

Impressions. By Ledwina H. Servos, R.N. 25 

Esquimalt Rural Nursing Service. By Helen Kelly, R.N 20 

Mission and Maple Ridge... ..Bv H. E. Fawcett, R.N 28 

The Kelowna Rural Schools Health Association. By Anne 

Frances Grindon, R.N 31 

Chilliwack. By Hilda Peters, R.N 33 

The Osoyoos, Testalinda, Oliver, Fairview, and Falls District. 

By G. M. Kitteringhani, R.N 35 

School-work ix Nanaimo. By M. Dorothea MacDermot, R.N. 37 

New Developments in the Kelowna City Schools. By Edith W. 

Tisdall, R.N 38 

The Pre-sciiool Visit. By C. Rose, R.N.... 39 

Port Alberni. By Mary E. Grierson, R.N 40 

Nanaimo. By Muriel Upshall, R.N. 41 

Onward. By Myrtle E. Harvey, R.N 42 

Health News from Kamloops. By Olive M. Garrood, R.N 43 

A Day at Bamberton. By Velma Miller, R.N 44 

My District Work, Past and Present. By Edith M. Walls, R.N 46 

Vernon Consolidated School District. By Elizabeth E. Martin, R.N. 47 

Revelstoke — A New Service. By Amy A. Lee, R.N 48 

The North Vancouver Health Unit. By Norah E. Armstrong, R.N. 40 

Public Health in Armstrong. By Pearl Charlton, R.N.. 52 

Health-teaching in Schools — A New Idea. By Bertha Jenkins, 

R.N 53 

Personals 54 



PROGRESS. 

The work of editing this, the eighth issue of the Public Health 
Nurses' Bulletin being completed, we have an opportunity to pause and 
glance back over the pages. In the tirst place, the very number of articles 
has increased from thirty to thirty-seven. The articles are longer and 
more interesting accounts of busy services. Progress is to be noted all 
along the way. 

Last year's Bulletin found us eager and enthusiastic following the 
challenge to renewed endeavour which we received at the Refresher 
Course. That challenge has been taken up and answered, as you will see 
as you read. Not only litis every nurse given her best in older organized 
nursing services in various parts of the Province, but also four new 
services have been inaugurated and have demonstrated their effectiveness 
and value. 

This Bulletin provides one means whereby we can transfer our ideas 
and impressions to one another. We have our national nursing periodical, 
the Canadian Nurse, and numerous other professional magazines where 
interchange of thoughts and ideals will benefit each one of us. Let us 
continue to make this Bulletin a reflection of our activity, resourceful- 
ness, and enthusiasm. The work will progress fastest if we give most to 
it, both in study and practice. The words of one of the verses used in 
various youth-training movements ring just as true in their application 
to our Public Health Nursing Service. 

" Up then ! 
Truest fame 
Lies in high endeavour. 
Keep the flame 
Burning brightly ever. 
Up then! 
Up and on ! " 

Your Editor. 



TEACHING THE TEACHER TO TEACH. 

Last fall 1 read a paragraph in a magazine article that struck me as 
being particularly significant. It was an outline of the responsibilities 
and duties of school-teachers. The analogy betwixt Public Health Nurses 
and teachers is very close. 

''Theirs (the teachers and nurses) is the responsibility of opening 
the doors of the mind of each following generation, and letting in the 
light. It is they who must call the attention to what is passing outside 
the windows of that railroad-car, going at express speed, in which we are 
making the journey of life. Without the teachers, the whole journey of 
the train would be spent by most travellers in the dining-car." 

Ever since the earliest inception of modern public-health nursing, 
teaching has been rated as one of the most important phases of the pro- 
gramme. The routine of bedside-nursing, the preparation of infant- 
feedings, habit-training in the preschool period, health-teaching in the 

3 



V 



school, group-instruction for adults — every step of the way it has been 
the function of the nurse to point out the important points along the way. 
We have been discussing and hearing arguments from teachers and 
others on the important point of direct class-room instruction in health. 
Since this subject is included in the curriculum for both high and public 
schools, it is recognized as something that is to be taught. Too often 
we hear from teachers: "But I know nothing about the subject." The 
weak link in this system seems to be in the actual teacher-training in 
public health and personal hygiene. Obviously, the individual nurse in 
her single district cannot be responsible for the sum-total of knowledge in 
health that the teacher requires. The nurse has such an infinite number 
of demands on her time that she cannot begin to cover all the territory 
she wishes. The logical solution seems to centre about the teaching of 
the fundamentals of public health to the students in the normal school 
or other teacher-training classes. A doctor or a Public Health Nurse is 
possibly better prepared to do this than a lay person. Let us strive for 
this, that our teachers may be better prepared to assist in opening np the 
windows of the minds of each succeeding generation. 

Margaret E. Kerr, K.N. 



STOCK-TAKING. 



Policy, budget, sales-slips, dividends, inventories, bargain-sales, etc. — 
what do these terms mean to the business-house? And what do the 
terms — objectives, records, statistics, annual reports, etc., mean to the 
public-health nursing organization? 

Is there not a decided similarity in the ideas the words suggest? The 
commercial house must be able to declare a dividend or its board of 
management will soon call the executive officers to task. Can a public- 
health organization demonstrate its gain and declare its dividends in the 
same way; or, if not in the same way, is there not some method of esti- 
mating whether it has attained its objectives? U will surely be agreed 
that some form of stock-taking is essential. 

What were the objectives of your organization last year? Was your 
salesmanship effective, or were some of your efforts wasted? Perhaps 
some of the fashions you had selected were too extreme for your district! 
The merchant sometimes ,k scraps " his mistakes by unloading them on 
the unwary purchaser as bargains. You may not have the same type of 
" bargain-day," but you must be prepared to drop even your pet project, 
for the time being at least, and to start out with a new " spring stock." 

There are different methods of stock-taking. There is the critical 
self-analysis; are we clear in our objectives and whole-hearted in our 
efforts to attain them? There is the monthly and annual stock-taking 
as the books are balanced and a report is submitted to our committee. 
The]] there is the professional stock-taking, when we submit to our fellow- 
workers a report upon some special phase of our year's Work, asking for 
their critical analysis and evaluation of our effort. Our work can, as 

4 



n rule, be justified in our own eyes only as we are able to satisfy our 
peers of its soundness — in objective, method, and result. 

Conventions and Refresher Courses therefore play an important part 
in this professional stock-taking. It is hoped that the 1031 Annual Con- 
vention of the British Columbia Graduate Nurses' Association and the 
Annual Refresher Course may show favourable balance-sheets. 

Mabel F. Gray, R.N. 



OPENING UP A NEW SERVICE IN THE PEACE RIVER. 

I will venture to give a little report of what the work has been since 
I came to the Red Cross outpost at Grand Haven in April, 1930. 

On arriving at Hythe, Alberta, (which was the end of the steel at 
that time), on my way to the Port St. John District to open the Red 
Cross Nursing Station in April, l()3u, I found that the roads were closed 
to all traffic on account of their bad condition. 

I stayed at Hythe the first night and travelled as far as Pouce Coupe 
the next day. The distance from Hythe to Pouce Coupe is 45 miles, and 
it took the whole day to make the trip. On two occasions our car had to 
be pulled out of the mud by horses. We spent the night at Pouce Coupe 
and next day came as far as Taylor by car, at which point is the crossing 
of the Peace River. On arriving at the river I found that the ferry was 
not yet put into operation for the season, and the only way in which one 
could cross the river at that time was in a small rowboat, which was very 
dangerous owing to the swift waters of the Peace and the heavy ice-floes 
which are so treacherous in the spring of the year. 

While at the river I was asked to see a trapper from Fort Nelson, 
which is 300 miles north of here. He had been accidentally shot through 
the leg, the bullet passing through one leg and lodging in the other. He 
was on his way to the hospital at Ponce Coupe, and while at the river 
I rendered what aid 1 could towards relieving his suffering. 

While waiting to get a car from the river I was asked to give aid to 
a man who had his feet badly frost-bitten. 

I eventually arrived by car at Grand Haven, which is 17 miles from 
the river, to find a. real nice log bungalow with live rooms, which is 
heated by a wood-furnace. 

The district is scattered and transportation is very difficult. There 
are very few graded roads. The saddle-horse is frequently the only means 
of reaching certain parts, and the travel then is over very bad trails. 

The work is both varied and interesting. In the first place, 1 have 
accommodation for two or three patients in my five-roomed bungalow. 
Until Dr. Brown arrived in July there was no doctor within (50 miles. 
I was kept very busy during my first three months here, answering calls 
for aid from all parts of the district. Now that the doctor is here, I refer 
them to him if it is necessary; but in spite of the doctor being here, I 
make long trips to see sick people. 

Since May, with the exception of seven days in July and ten days in 
September, I have had patients in the outpost, both general and maternity. 

5 



When busy in the outpost there is not much chance to visit outside. 
Whenever the opportunity comes I visit the schools, prenatal patients, 
infant-welfare, and pre-school children. 

There are ten schools in the district, which, with the exception of one, 
I have been able to visit. To some I pay a monthly visit, while others are 
too far away to be visited regular] v. 

I have delivered seventeen babies, ten in the outpost and seven 
throughout the district. Whenever possible, I visit the prenatals once a 
month. If they are too far away, as some are, they send a specimen and 
a note to say how they are. The letters they receive from the Provincial 
Board of Health seem to be much appreciated and they find them very 
helpful. 

In November a call came from 15 miles away to attend a mother, the 
man coming by saddle-horse. It was necessary for me to accompany him 
by saddle-horse, together with my equipment. When we had gone 8 miles 
we forded the North Pine River, which was very difficult to cross at that 
season of the year, water being 4 feet deep with ice floating. We rode up 
the pack-trail, which was very steep, and eventually arrived at the shack 
to find a kindly neighbour in attendance until mv arrival. All went O.K. 

Calls come in for various sicknesses. I stitched the face of a boy who 
had been kicked by a hor'se, and a man's hand which he had caught in a 
buzz-saw. 

There are approximately 4,000 people on this side of the river, scat- 
tered over a very large area. During the very mild winter which we are 
having there has been little serious sickness. The people all seemed 
pleased to hear that there was a nurse coining into the country, whom 
they could call on in case of sickness. 

All one seems to be able to do here is to render help whenever and 

wherever needed. . , r „ _ , , 

A. M. Roberts, R.N. 



WESTBANK, PEACHLAND, AND INDIAN RESERVATION. 

The nursing service of Westbank-Peachland District has just passed 
its first birthday, and it is my privilege to present this, its first annual 
nurse's report. 

Adjustments have been found necessary and much time has had to be 
given to introducing the work to the community that all may know that 
nursing service is available to every resident. In carrying out its gen- 
eralized service the Victorian Order of Nurses knows no colour, race, or 
creed. 

One hundred and seven families have received nursing care. Of 
these, sixty-nine were medical cases and three obstetrical where nursing 
care was given to mother' and babe. It is hoped some suffering was 
alleviated through giving of forty-three nursing visits to one cancer case. 
Twenty-five night calls were answered to all parts of the district and we 
appreciated the help given to the nurse in answering these calls, especially 
when the roads were bad. Thirty infant-welfare visits were made, the 
nurse weighing the baby and giving instruction to the mother. 

6 



Nineteen prenatal cases were given 1.35 visits, many of the expectant 
mothers seeking' advice from the nurse at this time. Once we can get the 
mothers of our country to realize the importance of prenatal care, then, 
indeed, we shall be building for a future generation of healthy citizens. 

Home-nursing and Mothercraft. — One home-nursing class with an 
enrolment of fifteen was organized in February, 1930. One mothercraft 
class was organized in January, 1931, with an enrolment of fourteen. 
The girls show keen interest in this work. 

Well-baby and Preschool Clinics. — Seven well-baby and pre-school 
clinics were held under Dr. Ootmar, with a total attendance of 108, which 
speaks well for' the value of the work to the mothers of the community. 

Tuberculosis Clinic. — A chest clinic was held in Kelowna in October, 
with Dr. Lamb, travelling diagnostician for tuberculosis, attending phy- 
sician. Eight patients, either suspects or contacts, from Westbank and 
Peachand Districts, availed themselves of this opportunity for examina- 
tion. 

School. — Regular school inspection has been given, with 106 follow-up 
visits to school-children, in the hope of encouraging the parents to have 
defects corrected before serious harm has been done. 

Dental Survey. — -A dental survey was made by Kelowna dentists in 
May, when 124 children were examined. As a result, cards showing the 
work required to be done, with a maximum estimate of the cost, were sent 
to the parents. Home of the children have had this work done. 

Twenty-four school-children were vaccinated against smallpox in 
Westbank bv Dr. Ootmar in Jalv, and twentv school-children in Peach- 
land by Dr. Buchanan in August. Clinics for immunization against 
diphtheria were held in the fall in Peachland, Westbank Town-site, West- 
bank Ferry schools, and at well-baby clinic for pre-school children. Diph- 
theria immunization was given to ninety-four, including nine pre-school. 

Health exhibits at Peachland and Westbank Fall Fairs created a very 
great deal of interest, and a health play, entitled "The Trial of Johnny 
Jones," put on by Westbank school-children at their fair was greatly 
enjoyed, if one could judge by the applause accorded them. 

At our Annual V.O.N, meeting in Peachland on January 7th and 
Westbank on January 8th we were very much indebted to Dr. Knox, of 
Kelowna, who gave us a very interesting and instructive health talk, 
stressing care of the child up to school age and annual health examination. 

We see much to be done in our school-health programme. We feel we 
have only knocked at the door, but trust that the ensuing months will see 



progress. 



Hilda E. Barton. P.N. 



FRENCH CREEK AND DISTRICT. 

Each year we look forward to doing great things, especially after the 
annual "refresher," when we receive so many new ideas for extending the 
work and giving a more efficient service. And each year we look back and 
realize that ours is not a service from which we get startling results, but 






is rather one of helping' to lay a sure foundation, upon which (as Miss 
Jones said) u a cathedra] will be built in time." 

Last year J worked very hard in Parksville District, when my other 
duties would permit, endeavouring to demonstrate the usefulness of a 
Public Health Nurse, and Parksville " came in " on the service last July. 
This means that I now have four districts instead of three; i.e., Parksville, 
Errington, Coombs, and llilliers. This is really loo much for one nurse, 
so naturally my programme is very limited. Interest in the nursing 
service in this new district is increasing, and perhaps the people respond 
more readily on account of the adjoining districts having had the service 
for some years. 

There has been a considerable increase in the number of maternity 
cases during the last two years, and although this limits one's activities 
in some respects, yet it increases the possibilities for educational work; 
for' I find that the people of any community are more open to conviction if 
the nurse can, and will, demonstrate her practical capabilities. 

I was very gratified when the School Medical Officer on his annual 
examination remarked on the decided improvement among the teeth of the 
children of my older districts. On account of the distance to town, the 
correction of the dental detects is so very much slower than could be 
desired, but we are gradually getting there. The children, too, are taking 
a greater interest in the care of their teeth. 

A hot drink at noon for each child carrying a cold lunch has been 
instituted in three of the schools, and this appears to be very much 
appreciated. 

In this community the parents are very prompt about reporting sus- 
pected communicable diseases, however slight they may appear to be. 
This is such a decided improvement on the old adage, " Let them have it 
while they are young." One case of scarlet fever in a school-child was 
immediately reported, diagnosed, and isolated, thereby preventing the 
appearance of any other cases. I cannot speak too highly of this child's 
mother for her' promptness in reporting, and for the intelligent manner in 
which she carried out the physician's orders. Needless to say, I am very 
proud that she was a member of one of my home-nursing classes. 

I addressed the W.I. Conference held at Qualicum in October, and 
was pleased to see some immediate results of my talk. I gave them " A 
Day with the Public Health Nurse," and of course explained each phase 
of the work as I went along, particularly stressing the need for adequate 
prenatal care. Statistics of maternal and infant mortality were my 
greatest ally in this, for statistics, if put in an interesting manner, never 
fail to impress one's audience. 

It is so very encouraging to feel that the work is extending. When 
1 think of the growth of the work in this vicinity as evidenced by the 
addition of the new district this vear, I am imbued with renewed en- 
thusiasm in the prospect of what the future holds in store. I believe that 
it is only a case of marking time until another adjoining district will 
" come in." Of course that will necessitate the services of another nurse, 

8 



and after that, time enough for all clinics and classes; in fact, such a 
programme as I can only now visualize, but hope to help " put over" in 
the not-ver'y-distant future. 

If we endeavour to keep the possibilities ever before us, then when 
we look back and see how far we have already travelled, we just cannot 
help knowing that we are slowly but surely " getting there." 

Margaret M. Griffin, R.N. 






THE SAANICH HEALTH CENTRE. 

Another year has passed and there have been more changes at the 
Saanich Health Centre. Miss Mabel Johnston was forced by ill-health to 
resign her position in May. Miss Mary McPhee, Nursing '30 F.B.C., 
succeeded her. In November Miss McPhee was appointed to the staff of 
the Child Hygiene Department of Vancouver. Miss Audrey Payne, a 
graduate of the Royal Jubilee Hospital, Victoria, has taken her place. 
Miss Payne came to us after a year's work with the V.O.N, in Montreal. 
In September Miss Mary Henderson accepted a position with the Van- 
couver' schools, and was succeeded at the Health Centre by Miss Clare 
Rose, a graduate of the St. Joseph's Hospital, Victoria. Miss Rose took 
a public-health course in Washington and followed up the work with the 
American Red Cross in Seattle. Miss Rose and Miss Payne have brought 
with them some new ideas and we are expecting to make advances this 
year. 

Our school and pre-school dental clinics are progressing well. 
Financial conditions are such that we are thankful to be able to carry on 
this work. Most of the children would be neglected were it not for the 
clinics. It still continues to be difficult to persuade parents of the 
advisability of repairing temporary teeth, but we are making headway 
and hope to overcome the most serious objections. 

Our infants and pre-school children have been more thoroughly 
visited, due to the fact that we have been more fully stalled this past year. 
Nursing visits have been about the same. This type of visit is of necessity 
made even at the expense of our preventive work, but there has been no 
increase in our bedside-nursing. This past year our number of free visits 
to chronic cases has decreased materially and we consider this a step in 
the right direction. 

By the time the Bulletin is printed we hope to have disposed of the 
last of the Model T Ford cars and to have a coach in its place. This will 
give us two closed cars and one open model. Car' expenses are down 
somewhat and our committee is finding it cheaper to get a better type 
of car. 

Our committee has co-operated with us very well and our thanks are 
due to the members of it and to the Provincial Board of Health for their 
unfailing assistance. 

Esther S. Nadex, R.N. 





UNIVERSITY HILL SCHOOL. 

As in former years, the Provincial Public Health Nurses have been 
kept well abreasl of public-health affairs through the medium of literature 
and letters sent out through his Department by our indefatigable Pro- 
vincial Officer of Health, to whom all praise and appreciation be given. 
Of the many and varied subjects placed before us for our consideration 
during the 1 !)•*><)-:> 1 session, perhaps the most interesting was that which 
hailed from the Okanagan Valley as the result of efforts put forth by Our 
very own Mrs. Grindon and Miss Tisdall. The fact of the Okanagan 
teachers sitting in conference with the nurses, and the honouring of repre- 
sentatives of our profession at the banquet afterwards, is a sign of the 
times in which we live, and bespeaks a great future for health-education 
work in the Okanagan. Upon reading about all these wonderful happen- 
ings as outlined in Mrs. Grindon's letter, I was inspired to visit the 
University Hill School and talk matters over with the principal, who 
hails from the Okanagan, and was principal of Penticton School for some 
years, in order to ascertain his opinion about health matters generally, 
and school-health education work particularly; but more of this later. 

It may interest my fellow-nurses to know something of the health- 
education programme as conducted by the teachers at University Hill 
School. The health plan, as such, is not very spectacular, and might not 
be considered in the light of a health-education plan at all when compared 
with some of the very progressive programmes as carried out in municipal 
schools, but 1 think it is very good and in certain respects quite unique, 
in that it carries out instructions, as outlined in Form II, for the guidance 
of teachers, in order to enable them to safeguard the health of the pupils 
committed to their charge. Form II was issued by the Provincial Health 
Officer as far back as 1913 ; therein, also, the duty of the teacher is pointed 
out in regard to the careful tilling-out and keeping up-to-date of Form A; 
the teachers being admonished thus: Pear in mind the card Form A has 
to last the whole school-life of the child; and, further, when a child 
transfers from another school' within the Province, secure his previous 
card. Both forms might very well be brought up-to-date in order to meet 
present-day requirements, but even as they stand to-day, if the instructions 
as outlined are faithfully carried out, they represent a valuable piece of 
health education for teachers, pupils, and parents alike. For example, 
teachers are requested to make 1 a routine inspection of all children at the 
beginning of each term ; explanations are outlined covering the exclusion 
and readmission of pupils; weighing and measuring with accurate record- 
ing of facts have a place too, and it is pointed out that a healthy child 
makes a more intelligent pupil. So much for Form A and its bearing 
upon the health programme as carried out at University Hill School by 
the teachers. Another important health measure and precaution taken 
by the principal of this school is that of each year preparing a list of 
names of those pupils who have never previously been vaccinated against 
smallpox; consent or reason for refusal is obtained in writing from the 
parents, and full information placed at the disposal of the Health Service; 
the procedure has resulted in a 90-per-cent. vaccinated school population, 

10 



including the five teachers. I look upon this as an excellent piece of 
health education, and of particular value to young teachers who are 
charged with the education of our potential citizens. 

Referring back to my discussion with the principal about health 
matters, he pointed out the difficulty of keeping Forms A and H because 
some of the questions are duplications of those required by the Education 
Department ; notwithstanding this, the Health Department requirements 
are carried out punctiliously, even to the exclusion of pupils who have 
uncovered sores, whom he will not permit in the class-room, and only asks 
that he be given a full measure of support from health officials, because 
his experience of parents in no way differs from that of any other worker; 
he finds grateful parents and those who are not only not grateful — with 
emphasis on the not — but very uncomplimentary into the bargain. The 
principal has a method of regularly checking the ventilation of class-rooms 
throughout the day by means of taking a class period in each room him- 
self; that is to say, a class period will last forty-five minutes, when the 
principal goes to another class-room, the teacher going to the room in 
which the principal has just completed the last period, and so on until he 
has been through all class-rooms himself. The benefit of this arrange- 
ment, he points out, is that it quickens observation regarding foul air in a 
given class-room, the teacher being apt not to notice the condition if 
stationed in the same room for all periods. He conducts classes in hygiene 
from Grade IV. on, but does not make it a credit subject; his effort being 
along practical lines, his desire being visible signs during the school-day 
of his subject having gone over. 

Then, gentle reader, you will be wondering what the nur'se does. 
Well, she is responsible for the regular inspections, vaccinations, follow- 
up, and hist, but not least, interviewing the grateful (and otherwise) 
parents. 

Summary. — The value of the foregoing programme depends largely 
upon what constitutes health education. Forms II and A place direct 
responsibility upon the teacher for the prevention and spread of com- 
municable diseases — a logical arrangement, since it is estimated that five- 
twelfths of the child's waking life is spent in school, and not infrequently 
teacher is the first " grown-up "' to see him in the morning. Regarding 
the duplication of history required by both the Education and Health 
Departments, this no doubt will be adjusted in the course of time. 
Finally, 1 would pay tribute to the principal and teachers of the Univer- 
sity Hill School, because they are the first I have met who take the Health 
Department instructions at all seriously as outlined in the forms men- 
tioned; in fact, remarkably few teachers and, let it be whispered, fewer 
nurses even know Form H by sight. While Form A may have the name 
of the pupil concerned inscribed thereon, the balance of the history is 
usually left to the conjecture of a bewildered School Medical Officer, and 
the rarity of transfer of Form A with the pupil is common knowledge and 
need not be elaborated here. 

C. A. Lucas, R.N. 



11 



CHICKEN-POX. 

One of the great tenets of health organization is the education of the 
masses in the matter of health. This in great part has been accomplished 
through the public-school teacher, and an attempt has been made to bring- 
home to these teachers certain truths, which may be exemplified by 
referring to a recent epidemic of chicken-pox. There has been some 
difficulty in destroying the illusion that all schools must be closed in 
order to control all epidemics. Teachers and parents share this belief 
and this epidemic of chicken-pox in North Vancouver did much to change 
this opinion. With this in mind primarily I have chosen as my subject, 
Chicken-pox. 

I do not refer to chicken-pox in the abstract, but to a definite epi- 
demic, which was traced to a very mild case of chicken-pox occurring 
during the Christmas holidays of December, 1930, and which I discovered 
on January 5th, 1931, when the daily absentee-list was turned in at the 
Health Unit Office. 

As is usual, when following up our absentees, I visited the home of 
this particular case and was told that ten days before, approximately 
December 25th, 1930, the boy had " some peculiar spots " which the 
mother called hives. Two days after the appearance of these spots the 
boy attended a Christmas-tree festival. On January 9th and 10th 
nineteen cases of chicken-pox were discovered, following up the report of 
absentees. Investigation showed that the school-children who suffered 
from chicken-pox had all attended the same festival and associated with 
the same case. This instance furnished conclusive proof that the incu- 
bation period is from fourteen to twenty-one days. 

The cases were immediately isolated and instructions were given to 
the mothers, explaining the precautions necessary to prevent the spread 
of the disease to the children of the families and to the neighbours 
children. 

The cases were among children attending different schools, thus 
showing that no one school could be responsible for the spread of 
chicken-pox. The fact that the schools were opened at the time made 
the cases easy of discovery and made possible control of contacts and 
the suppression of the epidemic. Further, the commendable co-operation 
of the doctors in reporting the cases facilitated the work of the Health 
Unit in controlling the epidemic. 

The most interesting phase in the history and study of this epidemic 
was the diversity of sign and symptom. The cases showed nearly all the 
varied distribution of the eruption mentioned in the literature, including 
mucous membrane of the mouth, the eyes, hands, and feet. In many 
instances large superficial pus blisters, the size of a 50-cent piece, 
appeared, and some left scars. Several of the cases considered apart 
from the epidemic might have been mistaken for smallpox. 

I should like to emphasize the following points: — 

(1.) That the epidemic started during the school holidays. 

(2.) How easily a mild case may cause an epidemic and give rise to 
severe cases, as well as the mild. 

12 



(3.) The tracing of the epidemic to the common source of infection. 

(4.) That the period of incubation is from fourteen to twenty-one 
days, with the majority from fourteen to sixteen days. 

(5.) Age group; all these children were approximately the same age. 

((J.) Diagnosis confirmed by six children showing marks of successful 
vaccination done within two or four years. 

(7.) How easily epidemics are controlled by isolation methods. 

(8.) A great deal of aid was given by the co-operation of the medical 
profession. 

Working on an epidemic such as this further confirms the great 
efficiency of the follow-up work of the Public Health Nurse. By this 
follow-up work parents and nurse meet on a common ground of co-opera- 
tion, understanding, and sympathy, and it is perhaps one of the greatest 
factors in education of mother and child and promotion of health. 

Elizabeth Lowtiier, K.N., 

Worth Vancouver Health Unit. 



THEN AND NOW. 



When I graduated as a Public Health Nurse I had very definite ideas 
about how I would organize in a new district. First 1 would have a 
good-sized photograph on the front page of the local paper, at least 
a month before I would arrive, with the announcement of said arrival, 
all my credentials published, etc. I had visions of closing hospitals and 
seeing all the people living a strictly hygienic life. All children would 
soon drink milk, eat lettuce, and be in bed at 8 every night. There would 
be no cancers, tuberculosis, or any infectious diseases in the district as 
a result of my public-health programme. All this, and even more, was 
to be quite fully accomplished in at least four or five years. These visions 
came in spite of being warned in classes that we must expect the work 
to move slowly, etc.; but / would make things hum when I started in a 
district of my own. I would get school-work well established; hold 
a baby clinic each week, with all the babies in town attending; have 
a monthly T.B. clinic; be in every home and know every man, woman, 
and child by their first name, in the first year. 

So much for untried theories — now something practical. This is 
another story. 

When I arrive in the district 1 find that many have not seen the 
paper containing my advance notice, and have never heard of me — did 
not even know there was to be a nurse — a Public Health Nurse. What 
does she do, anyway? 

After much explaining here and there in small groups and in homes 
for a few months, people begin to know who T am and something about 
the work I am trying to do. I soon find out that great distances, weather, 
and many factors prevent having baby clinics for some time; in fact, 
I was in one district three years before I even had a weighing-station 
running properly. I had for a long time to be content with seeing a 
few babies in the homes. There is no doctor to take charge of the T.B. 

13 



clinic, so that plan must be tabled for the time being. Many people cannot 
afford to pay the doctor and dentist, so correction of defects in children 
must be delayed. So one works on for months amidst this delay and 
that, and finally must feel resigned to report about one-third as much 
work really accomplished as was first planned. 

Experience is a good teacher. It may be an expensive and slow 
method of obtaining knowledge, but one learns many interesting lessons 
as a Public Health Nurse. It is surprising from whom and under what 
circumstances these lessons come in the school of experience. Day after 
day and week after week knowledge accumulates. Wisdom may linger 
when it comes to making use of the lessons, but if the Public Health 
Nurse maintains her sense of humour she will have gone far towards 
success. She must not be discouraged by disappointments, but look for 
the silver linings that are always to be found somewhere, firm in her 
conviction that eventually will dawn that day so well described by Lord 
Tennyson : — 

"All diseases quenched by science, no man halt, or deaf or blind. 
Stronger ever born of weaker, lustier body, larger mind." 

Perhaps I have allowed the pendulum to swing too far the other way 
and am content with too little, but I believe I have really learned now 
that Koine was not built in a day. 

Our progress in Penticton has been encouraging. Work was started 
only last September in the schools, so one cannot draw conclusions as to 
results in such a short period. But school attendance has been better this 
year, the classes continuing without interruptions by infections diseases. 

Although my work has been almost entirely connected with the school, 
I have had some opportunity of advising mothers in the care of smaller 
children when in the homes. 

We are having Aveekly health talks in each class in the elementary 
school, and classes in baby care and home-nursing in co-operation with 
the Home Economics Department of the Junior High School. 

We are carrying on quite a successful milk campaign at present, 
with the object of getting more children into the milk-using habit, and 
supplying milk to those who do not have it at home. 

Much of the success I have had is due to the splendid co-operation 
received from the School Board, teachers, doctors, and parents. In fact, 
every one seems interested in improving health, and with such combined 
effort we are hoping for even greater things in the future. 

M. A. Twinnv, K.N., 

Penticton. 



LADYSMITH. 



On my arrival at Ladysmith about five months ago I was pleased to 
find the district in general in a well-organized condition with regard to 
public-health work. 

The school dental clinic under Dr. Verchere, which was recom- 
menced last year, has been carried on most successfully. Practically all 

14 



the important work on the children's teeth has been done and a satisfac- 
tory scheme for follow-up work adopted. 

I have had the hearty co-operation of the School Hoard throughout 
in the dental work, and we are endeavouring to make arrangements for 
the children from the country schools in the vicinity to attend the clinic. 
The School Board has a dental chair and all the work has been done in 
the health-room of the public school. 

Probably the most progress this season has been made by the well- 
baby and pre-school clinic. The first clinic was held at the Ladysmith 
Agriculture Fair last September, sponsored by the Oyster Bay Women's 
Institute, and so much interest was shown that a regular fortnightly 
clinic has been organized. These are held at the school health-room with 
very encouraging results. The mothers from the surrounding district 
have been invited to attend the clinic and they have certainly availed 
themselves of the opportunity, though owing to difficulties of transporta- 
tion I have been unable to do as much of the following-up work as I 
should have liked. 

Dr. Lamb paid us a very welcome visit, and his report shows that 
conditions in the district are generally satisfactory. 

I am sorry to report that our Medical Health Officer, Dr. Maxwell, 
and also Dr. Baird are leaving the district. Both the doctors have been 
untiring in the assistance they have rendered to the baby clinic and 
public health generally, and the thanks of the district are due to them 
for their nmcli-appreeiated elf'orts. 

J. Worth ington, B.N. 



PUBLIC-HEALTH NURSING IN MONTREAL AND SAANICH. 

One must realize that this is not so much a comparison as an obser- 
vation of public-health work in two very different districts; i.e., Montreal 
and Saanich; one a congested city, the other a rural community. Thus 
the problems of the city are not the problems of the country in most 
cases. These individual difficulties are no easier to solve in the city than 
the country. The health-workers' road is rocky, but they must consider 
the future and not the immediate present. The foundations we are laying 
are for the generations to come. 

Naturally the'methods of instruction have to be adapted to the par- 
ticular district in which they are carried on, but this in no way affects the 
aim which all public-health workers have in view, no matter what the 
district — education. 

I think the proverb, " Chai Ly begins at home," might be paraphrased 
as " Public health begins at home." It is only reasonable that one cannot 
teach anything convincingly that one is not already convinced of oneself. 
This is being carried out to a certain extent in Montreal. The Public 
Health Nurses are subjected to a thorough physical examination once a 
year at least, and oftener if necessary. This is being enforced in some 
of the larger training-schools too, and is not limited to Public Health 

15 



Nurses. The V.O.X., one of the largest public-health organizations in 
Montreal, has its own physician, who attends all V.O.N.'s free of charge. 
The nurses are X-rayed at the least suspicion of chest-trouble, and blood 
tests done if they appear anauuic and run-down. In this way the nurse 
is practising one of the principles she teaches to her patients — prevention 
rather than cure. 

In the Province of Quebec great stress is laid on prenatal care and 
the prevention of tuberculosis, due to the fact that that Province has the 
highest infant-mortality rate and the greatest number of tuberculosis 
patients. As there are more cases of tuberculosis than the sanatoria can 
care for, an appreciable number are cared for in the home. As there are 
more patients suffering from tuberculosis being cared for in the home in 
Montreal than in other districts, the nurse must be prepared to give very 
explicit instructions re the care of the patient himself, and for the safety 
of the other members of the family. The prenatal work in this city has 
made great strides in the last two years. A great deal of the success in 
this branch of the work is due to the co-operation of the Metropolitan 
Life Insurance agents and the doctors, who report all their cases as soon 
as they are notified and request that they be visited. The patients them- 
selves are glad to have the nurse visit them and help them make their 
preparations for the confinement, which usually takes place at home. 
Very few patients among the working-class of Montreal go to the hospital 
for their confinements. 

In British Columbia, where even in the rural districts the majority 
of maternity cases are sent to the hospital, the nurse does not come in 
contact with as many prenatal s. They do not seem to feel the need for 
a^nurse as much as the patient who remains at home. The first visit to 
a, prenatal remaining at home for her confinement is usually to advise 
her about preparations for the confinement and to ascertain the date of 
the impending event. The nurse often solves many of the worries attend- 
ing pregnancy during this first visit, and so is welcomed back again when 
something new may be instilled into their minds. On the other hand, 
the patient expecting to be confined in the hospital does not have to 
worry about preparations, and thinks that two or three visits to her 
doctor are all the supervision necessary during pregnancy. 

The control of contagious diseases in British Columbia seems to be 
more wisely exercised perhaps than in Montreal. In Montreal, unless 
the patients live within the city limits, it is too expensive for them to go 
to the isolation hospital, as the people living in the suburbs, such as 
Verdun, are charged double in the city isolation hospital. This means 
that a great many cases are cared for in the home by the communicable- 
disease service carried on by the V.O.N. However, the breadwinner of 
the family is not quarantined, but goes out to work as usual, riding on 
crowded street-cars and working side by side with his fellow-workers. 
This state of affairs tends to spread the disease rather than curb it. 

Here in Saanich the nurses are carrying on more work among the 
school and pre-school children than in Montreal. The fact that a child 
is not allowed to return to school after an absence of three days without 
a permit from the nurse means that a check is kept on the child's health 

10 



and home conditions. Also younger members of the family come under 
the nurse's supervision, of whom perhaps she had not been previously 
aware. 

I believe that a certain amount of publicity is necessary in public- 
health work. The work being carried on and the results obtained should 
be kept before the public to stimulate their interest. Practical demon- 
strations are always impressive and give the people a clear idea of the 
work and methods used to accomplish the results presented to them. 
This is a very usual form of gaining public attention in Montreal, and 
has met with the success due such an undertaking. A rather unique 
method of publicity was the calendar lor 1C30-31 distributed by the 
Provincial Bureau of Health for Quebec. On each of the twelve pages is 
pictorially represented one or more of the activities of the Department, 
explained so clearly that even a child may understand. 

Regardless of the district or country, there are always obstacles in 
the path of public-health workers that only time and hard work can over- 
come. To each particular district their troubles seem to be the most 
involved, but if they realize that other districts are battling against their 
troubles too, all with the same aim in view, public health cannot but 
become more firmly established and the difficulties obliterated. 

Audrey B. Payne, R.X., 

Saanich Health Centre. 



KEREMEOS, CAWSTON, UPPER AND LOWER 
S I M I LKAMEEN RESERVE. 

On the whole, the year T have spent here has been a busy one and 
full of interest. The work is varied; besides the health instruction in 
the schools and the carrying-out of all prevention measures, all cases of 
illness are brought to my attention. I try to cover all branches of a 
generalized programme, as it is the only type of health- work thai tits in 
well in this community. 

We are handicapped by being so far from a physician. When a house- 
holder has to pay $35 for a single visit from a doctor he usually hesitates 
to call the doctor unless the case is very urgent. When we are in doubt 
at all we telephone to the doctor, who usually decides to have the patient 
sent to a hospital under his care. One visit from a doctor is not going to 
do much good, anyway. We have become quite expert in making up beds 
in the back seat of a car and (he 32-mile trip evidently does no harm. 
An acute appendix is my chief worry. The symptoms of appendicitis do 
not always follow the rules laid down in the text-books, and a car ride 
would not be particularly beneficial. 

Frequent inspection of schools and keeping the teachers posted as to 
the symptoms of various diseases and immediate reporting of absentees, 
followed by a home-school visit, keeps a pretty good check on the infectious 
diseases. 

17 



I organized a toxoid clinic in October. Dr. D'Easum was very much 
in favour of immunization and entered into the spirit of the thing 
splendidly. We inoculated twenty preschool, sixty-eight school-children, 
and three teachers. This represents at least three-quarters of the school- 
children in the district. 

The clinic was conducted in the school. The doctor brought several 
2-c.c. syringes and lots of needles. We had a gasoline-stove for boiling 
up the needles. Everything went on smoothly and quietly. During the 
whole procedure there was scarcely a sound. There were practically no 
reactions, the attendance at school being particularly good during this 
period. 

At Cawston the Women's- Institute took it upon themselves to pay 
the doctor's expenses for the clinic there. Being a small institute, they 
devote their energies to the local needs. 

Just before Dr. D'Easum, our Medical Health Officer, left in December 
we had four cases of smallpox in the district. This of course precipitated 
a vaccination clinic. We held one in the school and one in my office; 
172 were vaccinated. 

I hold a well-baby clinic twice a month. The pre-school children 
come once a month. We only weigh and measure the children, distribute 
health literature, and discuss matters pertaining to the health and well- 
being of mothers and babies. The Keremeos Women's Institute kindly 
loan me their meeting-room for the clinic. 

I carry out a prenatal programme, canvassing those who do not 
report within a reasonable time. The majority report about the fourth 
month. I often have to arrange for an appointment with the doctor and 
also for transportation for the patient. I find that it takes considerable 
persuasion to have the mothers go for their sixth-week postnatal exami- 
nation. But reminding them that they are not getting full value unless 
they go, helps. 

Regarding correction of defects for school-children, some progress has 
been made. Four children, beginners for September term, had tonsils 
and adenoids removed during the doctor's sojourn in Hedley. 

A travelling dentist comes every three months. I get as many 
children as I can to go to him for dental work. I can help transporting 
them, anyway. Defective teeth are very noticeable here, chiefly, I think, 
because Ave have had no dentist for nearly two years. 

I found severe eye defects this spring during our annual physical 
examination. These have been attended to. 

So, on reviewing the work, a little has been accomplished, but there is 
much more to be done. 

I must say I get splendid co-operation from teachers, School Board, 
and parents. Doctors, too, are always willing to help and to advise and 
co-operate in every way possible. 

I enjoyed Miss Kerr's visit this spring very much too. It helps to 
talk to some one who understands. 

I also had a visit from Miss McMann and Miss Hall, V.O.N, super- 
visors. This was in connection with the Indian work in the Similkameen. 
There is a great deal to be told about the work among the Indians. The 

18 






problems there would til 1 a good-sized volume. I shall dwell on that some 
other time. 

The Department of Health is always helpful and seems to radiate 
friendliness and interest through all its correspondence. 

B. Thomson, R.N. 



A DENTAL CLINIC IN A RURAL DISTRICT. 

It all began with a little 5-year-old saying to her mother: "See, 
Mummy, I've got two teeth in the same place, right in front. Isn't that 
funny?" 

The mother watched, with sadness in her heart, as the new teeth 
finally developed with a crooked bite ; one pushed right inside the bottom 
teeth, the other normal, quite spoiling the beauty of an otherwise pretty 
child. 

" Oh, why," she said, " cannot we have a dentist within reasonable 
distance to which we can take our children? '• And then came a further 
thought: " I am not the only mother whose children's teeth need attention. 
Many a child, less healthy than mine, is suffering from toothache. Did 
not our Medical Inspector last year report 'teeth needing attention,' and 
nothing has been done?" Indeed, what could be done, as at that time 
visiting a dentist meant either a trip to a city by boat (over 100 miles 
away), or' by a gas-boat to Vancouver Island; there, catching an early 
morning stage over rough and narrow roads, to a small city, returning late 
in the evening — a tedious and expensive day. 

So we followed on with : " Would it be possible to get a dentist to 
visit us, if we mothers combined and organized? r The local Women's 
Institute was consulted and the Secretary sent a letter of inquiry to the 
Provincial Health Department, Victoria. A courteous reply was shortly 
received from the Provincial Board of Health. 

Extract from letter dated March 16th, 1928: "As regards a dental 
clinic, we should be glad to assist you if you get in touch with the neigh- 
bouring schools, and we will probably be able to arrange for some service 
during the summer months. It is difficult to get a dentist, but we might 
be able to get one who would take a holiday and spend a couple of weeks 
in the district." 

This was the starting-point. The idea that the school was the place 
to start suggested a study of the School Law. Here we found that a 
thorough examination of the children's teeth could be arranged for by the 
School Boards (sees. K\ (/) and 102 (/)). 

We approached the School Boards of our island — at that time we had 
three local schools — and they were quite willing to have their sacred pre- 
cincts invaded. A dentist was found who had commenced to visit our 
nearest point on Vancouver Island once a week. We approached him as 
to whether he would take over the examination. The Women's Institute 
put up the boat-fare. The car transportation to the three schools was 
given, and an exhaustive examination of the children's mouths was under- 

10 



taken, the dentist's fee and any other expenses he thought fit to charge 
being borne by the Government. The result was horrifying; 95 per cent, 
of the children need attention badly. Some had every molar in their 
jaws decayed. 

Then the first clinic was arranged. The dentist promised he would 
spend a week with us in the summer, provided we would guarantee the 
bills and a sufficient number of children to make it worth his while. 
Further appeal to the Government brought the cheering news that in 
order to help out these long-neglected mouths they would guarantee 25 
per cent, of each bill, leaving the dentist to collect the balance ; but in the 
case of those certified indigent by the institute the Government would 
bear the whole expense. 

So the first clinic was arranged for August, 1928, and was very suc- 
cessful. Nearly all the children attended (a few had been to town during 
the holidays). The parents paid what they could and the Government 
made up the deficit. Institute members gave the dentist board and room, 
boat-fare, and transportation to the children. The dental apparatus was 
set up in the Church Hall by permission of the Yicar. There were a few 
dissenting voices — that the dentist had put in fillings which dropped out 
immediately, and that he had even made holes to put the stoppings in ; but 
these grumblers were mostly to be found among the indigent class. It 
was something of a shock to learn that, after Ave had done our best, 
another large bill had gone in to the Government for further clinic ex- 
penses; this was, I believe, paid. We began to wonder if our first real 
snag had been to choose a dentist who rated his services exceptionally 
high, but it was such a favour to get a dentist at all ; the work Avas AA r ell 
done, so Ave must carry on at all costs. 

Noav, our first object Avas to become self-supporting. Hoav Avere Ave to 
do without Government aid, and, most important of all, how were we to 
secure attention for' every child? 

The school trustees, says the School LaAV, can provide a dentist and 
need not collect the bills unless they think fit, in which case the bills are 
borne by the ratepayers. The GoA^ernment, Avho could not be expected to 
continue the first generous allowance, offered as a permanent assistance 
50 per cent, on all bills of those stated by the School Board to be unable 
to pay. A little arithmetic Avorked out as follows : Bills amounting to 
something over $200 for forty-odd children averaged, roughly, an allow- 
ance of $5 a year per child. For a school of twenty children a sum of $50 
Avould pay half of each child's bill — $2.50 per child — the balance being 
paid by the parents oi v , if indigent, by the Government. 

Thus the dentist is secured, and with a prospect of two or three 
schools does not mind the inconvenience of setting up his chair in a neAv 
place for a feAv days each year, especially as there are always some adults 
Avho are only too anxious to be spared a trip to town. 

Theoretically, so far, so good. But to continue my story. 

OAving to the law of the Education Department that annual school 
meetings be held at the same and identical time, I Avas unable to be in 
three places at once. I therefore Avrote doAvn my ideas as clearly as I 

20 






could, asking each School Board to vote |50 as a fund towards the estab- 
lishment of an annual dental clinic, the money to be spent on the children 
of ratepayers only (any renters being usually able to pay the full bill). 

My own school, where I was able to endure a fusilade of questions, 
passed the measure, and has done so ever since. 

School No. 2, since closed because of the dwindling attendance, 
turned it down indignantly — one parent going so far as to say that he 
believed that cleaning the teeth rubbed off:' the enamel. The Secretary, 
who was on my side, told me privately : tk I think, if you can get the clinic, 
the children will attend all right, only they will have to pay the full bill." 
This, as a matter of fact, they did ; their bills being a quarter of what they 
were the year before. 

School No. 3 was very vague. " We were rather hurried, " the 
Secretary told me, " and there was not much discussion, but there will 
be plenty of money to allow $50 for the purpose, I think. No, it wasn't 
clear about each ratepayer getting half off their bills. They said they 
would pay all if they could." 

And so the second clinic was arranged, full of mistakes and snags and 
pitfalls, some of which have not yet been rectified. I record them so that 
other districts may take warning from our experience. 

I started with the impression that the good-will of the parents was 
mine — that all I had to do was to produce my dentist and they would rush 
to place themselves in his hands and pay his bills. With this erroneous 
idea, I omitted the Government inspection, to save expense. Herein lay 
the mistake, as the parents, judging only by the absence of toothache, con- 
sidered the teeth did not need fixing, as they had been done " so recently " ; 
had they had the little blue scored cards, fear might have entered their 
hearts and their attitude would have been a call for help. Also, if the 
dentist gives a duplicate summary of affairs, it helps in making personal 
calls and is a check on neglectful parents. 

Mistake No. '2. The children were taken in batches from school for 
treatment at the dentist's office. There Avas an outcry from some parents 
who had misunderstood or not read the notes sent home a few days before, 
in which it was stated that this would be done unless they wrote request- 
ing otherwise. One mother said : " I knew my husband wouldn't want 
the children to go, so I burnt your note before he came home." Then, 
when the children were carried off, the husband loudly declaimed against 
compulsion, but the children smiled. Afterwards the mother thanked the 
convener on the quiet and the Government paid the bill. 

Another case was two 12-vear-old children, newcomers to the island, 
with badly neglected mouths. The children were so anxious to accompany 
the convener and have the work done that one rather took the guardian's 
permission for granted. Later, when they left the island with the bill 
unpaid, it was a heavy item for the School Board and they naturally had 
to blame somebody. 

Still another' instance (has not every district one or two of these?). 
The father wailed that he didn't see the need of fixing children's teeth, 
or, as he put it, paying for cleaning and fussing with them; but if the 

'21 



Government liked to do it, it was all right with him. For himself, he 
couldn't, or wouldn't, and therefore didn't. Poor children ! Such a 
father ! 

But the worst snag' of all was the dentist. Fussing because more 
children did not come, charging for minutes spent in chatting or' between 
the patients' visits, and finally, faced with an array of unpaid accounts at 
the end of his stay, he demanded settlement at once. 

The distracted School Secretary of No. 3, forgetting that Government 
help had been promised, and only remembering the $50 limit on the school 
funds, paid this over in full, thus settling up for the large bills of the 
unwilling ones, whereas he should have only paid half of each account. 

At the July school meeting the ratepayer's, especially the ones Avho 
had paid, demanded to know where this $50 had gone, and firmly refused 
to vote any more money for such foolishness. A refund of nearly $25 
later on, from various sources, helped to smooth matters somewhat. 

Another year went by, and I prepared, rather wearily, to see what 
could be done about dentistry. 

The inspection duly took place, but I could arouse no interest in a 
clinic. I commenced a lengthy correspondence with the dentist re time 
and place, but could not come to an agreement as I could not promise any 
definite number of pupils, neither could I decide who Avas to pay the clinic 
expenses he demanded. Frankly, the people were not interested ; even 
the institute suggested " tea and adjournment" when the medical report 
was mentioned. 

Then, the little cards did their work, in spite of the fact that there 
were teeth marked faulty which had not yet arrived, and teeth marked 
for extraction which were much better left in. (This is a fact; I cannot 
explain it!) The situation was saved by a chance visit of a travelling 
dentist, who tied up at the wharf for a day or two on his way north. He 
was besieged by anxious parents, and he delayed as long as possible while 
many families received clean sheets for their little blue-scored cards. We 
asked him if he would take the clinic, and he said: " Yes, but not for six 
months." There would be no " clinic expenses " — all that was necessary 
was to bring the children to him to have their teeth fixed at the regular 
rates. And this is what actually happened and which constituted the 
third clinic of 1930. 

With the change of dentist much of the antagonism vanished; as, also, 
the mysterious allusions as to " what she was getting out of it," after the 
dentist's clinic charges were eliminated. The parents of our own school 
had always been friendly, and quickly arranged appointments for examina- 
tion and repair. The bills were quite small and reasonable; these 
children having had regular attention, the mouths are getting into fine 
condition ; the dentist remarked that there were few districts on the Coast 
that could show a better set of mouths ; the School Board paid the half of 
each bill, and as the sum total was $28 they have only to vote that amount 
this year to keep their allowance of $50 on their books; the other half of 
the bills was met by the parents; there were no indigents and therefore 
no Government assistance. 

22 






So far, so good; but what of the other school, which had not any 
support from the funds of the school? Many parents took advantage of 
the presence of the dentist, and saw that their children were attended to ; 
but not all. These neglected ones must be rounded up after the next 
inspection, which will, 1 hope, be undertaken by the dentist who has taken 
over the work; and I feel quite confident that either by the help of the 
Women's Institute or by private sources we will be able to get them seen 
to. I do not quite see how we can get all the children attended to with- 
out the help of the School Board, and that seems a little difficult in the 
present instance owing to the mismanagement mentioned above. 

But, after all, we have only worked for three years. The Provincial 
Health Officer, in one of his helpful talks, told me once that he looked 
for a clinic to be self-supporting in five years, so we have two years yet to 
go before we can expect to have things running smoothly. I believe the 
new Secretary of the School Board in question to be in sympathy with 
the clinic and together we shall evolve some plan. The statistics of the 
third clinic — seventeen children, as compared with over forty in other 
years — does not really state the true position, as the dentist found himself 
very busy for ten days with adult work, as well as with the other children 
who do not show upon the tabulated list. 

In conclusion, I am happy to be able to tell you that, with proper 
dental care, the little crooked tooth that was the original cause of all 
this effort is now quite straight. That and the loving smiles of all my 
"island children" is reward sufficient for any one plain mother. 

A Lay Worker. 



ACTIVE IMMUNIZATION AGAINST DIPHTHERIA, 

KELOWNA. 

Since prevention is the key-note of all public-health work to-day, the 
campaign against diphtheria was undertaken not because there was an 
epidemic in the town, but to forestall the possible occurrence of snch an 
epidemic. Last year our efforts were concentrated on scarlet fever, when 
297 school-children received inoculations; this year diphtheria-prevention 
has claimed our attention. 

The campaign was begun early in October. Over 1,000 pamphlets 
written by the Health Officer of the district, Dr. Ootmar, explaining the 
procedure, giving the dates for the proposed clinics, and the places they 
would be held, were sent out to the parents. The general public were 
educated b,y a health film entitled " New Ways for Old," which was shown 
at the local theatre. Dodgers and free literature were also freely dis- 
tributed. Interviews were arranged for people interested in the subject 
and the whole matter thoroughly explained to them. The educational 
work undertaken the previous year in connection with the scarlet fever 
inoculations and the results of the campaign, not only in the low number 
of actual cases occurring here, but also with the comparison of figures in 
towns where such preventive measures had not been taken, did much to 
put the second campaign over. 

23 



Two tests were first given, the Schick and the toxoid reaction. In 
the latter test thirty positive reactions were obtained. These thirty were 
eliminated from any further inoculations. All told, nine clinics were 
held, with a total attendance of 1,420, which included school-children, 
teachers, and some pre-schoolers. A total of 1,874 inoculations were 
given. In no cases were there any marked reactions reported; slight 
indispositions in the nature of a mild general malaise were noted in some 
cases. A few of the cases developed rather swollen arms, but they soon 
subsided under' treatment. 

A more detailed report of the campaign follows : — 

Schoolchildren, 454: Schick test, 454; positive, 284; first inocula- 
tion, 329; second inoculation, 308; third inoculation, 293. 

Pre-schoolers, 5 : First inoculation, 5 ; second inoculation, 2; third 
inoculation, 1. 

Teachers, etc., 9: Schick test, 9; positive, 4; first inoculation, 4; 
second inoculation, 3 ; third inoculation, 3. 

Children completely immunized: 1930, 293; 1929, 1G. 

Pre-schoolers completely immunized : 1930, 1. 

Teachers, etc., completely immunized: 1930, 3. 

Edith W. Tisdall. R.N. 



PUBLIC-HEALTH NURSING IN FERN1E. 

The country in general is doing a great deal of pessimistic grouching, 
but I think it is much the same as the feeling we all (or mostly all) get 
after the Christmas holidays; the remedv for which is usuallv calomel. 

We have been so prosperous, and luxuries have become as common 
as necessities, until we are fairly gorged with them ; and this general 
lassitude and depression in all branches is also the natural outcome of 
such conditions. A little plain fare and the calomel of abstinence from 
luxuries may be the means of restoring our natural and national cheerful- 
ness and optimism. 

Upon looking back over my work here, I find : — 

Re Teeth. — The conditions have improved at least 75 per cent, and 
the children take a keen interest in trying to keep up to standard. In the 
high school almost every student has a good set of teeth, and they are 
kept beautifully clean in the majority of cases. Amongst the younger 
children a great many defects are not corrected, but, wherever' it is 
financially possible, the parents have the children go to the dentist when 
necessary. A great many children over whose first set I worried have 
perfectly beautiful permanent teeth; and a few who never use a tooth- 
brush have teeth that glisten like pearls — so there is some influence besides 
the Public Health Nurse which conies to their aid. 

Be Goitre. — -We have had and still have quite a number of cases, but 
the majority of them begin to disappear at the age of puberty. The 
exceptional cases are treated by their own physicians, and quickly respond 
to the treatment prescribed. 

24 




Re Contagious Diseases. — The winter so far has been exceptionally 
mild, and beyond two cases of chicken-pox we have had nothing since 
last spring. 

Be Skin-diseases. — We have had two cases of scabies, which qnickly 
responded to treatment; and that is all we have had since last spring, 
beyond slight affections which I am able to treat and keep the child in 
school. 

Re Chest Conditions. — Again, this year, even the " common cold ?? and 
cough have been conspicuous by their absence. Dr. Lamb, Travelling 
Medical Health Officer, visited us in October and saw all suspects, report- 
ing several to have made good progress. One of our boys who left school 
last year is now a bed patient and will go to Tranquille as soon as he can 
be taken in. His case has come under notice before the trouble has 
become very serious. Two of our small children are still in the Solarium 
and are reported making good progress. Those who have returned to 
Fernie are trying to carry out the instructions given to them by Dr. Wace. 

Our work this year has included a great deal of relief-work, and in 
that respect the co-operation from all sides has been a real joy. T am a 
member of the I.O.D.K. and also the Benevolent Society, and working in 
conjunction with these institutions prevents so much overlapping and 
saves so much time in investigating. The City and Provincial Police 
Forces also give splendid aid, and the City Council has things well in 
hand. This Christmas we formed a Christmas Cheer and Belief Fund — 
the Relief Fund part of it to remain in operation as long as it was needed 
and the funds lasted. The community contributed splendidly and we 
were able to give generously to all in need, and hope that the remainder 
of the fund will carry us through until the spring, when road and city 
work will open up again. 

As formerly, the interest and help of the parents has been splendid, 
and the school staff, doctors, and School Board have co-operated at all 
times in the most courteous manner. 

In closing, I should like to add a word of thanks and appreciation to 
the Provincial Health Officer and his staff for the ready help and under- 
standing which we receive from them at all times. 

Winifred Seymour. R.N. 



IMPRESSIONS. 



As I have been in the district only about six weeks I have not much 
to relate. The area I cover is a fairly lar'ge one and includes eight 
schools, six of which are visited weekly, with general inspections monthly; 
the other two, being very distant and transportation most difficult, are 
visited less frequently. 

Upon arriving at Duncan the beautiful scenery impressed me greatly; 
an air of peace and quietude seems always to per'meate the atmosphere; 
this, together with the kindly consideration and helpfulness of our Pro- 
vincial Health Officer, should provide sufficient inspiration for a Public 

25 



Health Nurse to do her best, apart from the variety of interesting cases 
met with daily. 

My impressions received in the various schools were of pleasure as I 
noted the evident interest of the majority of the pupils in health instruc- 
tion and general cleanliness;, and the excellent co-operation of the teachers 
in all matters relating to health. 

The idea of prevention rather than cure is often difficult for the public 
to realize; however, health-teaching is beginning to be understood by the 
laity, and they are appreciating the fact that a system of training in good 
health habits systematically taught in all grades proves an incentive to 
better work on the part of the child and is a link between the home and 
the school. 

Children are more susceptible to suggestion than adults; young 
people must be led to desire good health because of what it will aid them 
to accomplish. Health in the abstract makes no appeal to children, but 
as an aid to achieving undertakings in which they are vitally interested 
will take a firm hold of them. 

Rather an amusing and striking example of suggestion was exhibited 
on the part of a class in one of the schools I had been speaking to about 
posture. The teacher informed me the class later were discussing the 
subject, and several remarked they would rather stand straight and not 
look like a " question-mark." I had used the question-mark as symbolic 
of the appearance of poor posture. 

The day has gone when it can be assumed that young people will 
adopt healthful modes of living without anything being said to them 
about the matter, or without making a study of the requirements for the 
promotion of health under present-day conditions. The first and chief 
essential, therefore, is that pupils should be made aware of the habits 
necessary to develop healthy living and maintain vigour for every-day 
needs. It is only by patient and cheerful endeavour that the trail of 
effective effort will broaden into the highway of accomplishment — but it 
can be done. 

Ledwixa H. Servos, R.N., 
Cowichan Health Centre, Duncan, B.C. 



ESQUIMALT RURAL NURSING SERVICE. 

Those of us who have been engaged in the public-health service for 
some years have been asked this year to write something "along compara- 
tive lines. 

Last year also, my contribution was along the lines of comparison ; 
but whereas my last effort dealt more particularly with the actual con- 
ditions as we found them, compared with conditions at the time of 
writing, this time I would like to go a little ceeper and compare, if 
possible, the trend of thought to-day with that of a few years ago. 

We all remember those first few years, when a small band of nurses 
went out into the field at the request of the man who foresaw what 

26 



public-health service would mean to the country. Then there was,' no 
beaten path for us to follow. It was a new movement, and we were 
working under difficulties, more or less in the dark, and groping and 
working towards the light. 

Gradually, by illustration and demonstration, we managed to get 
some of the people interested and organizations were forme:! to help the 
work along. Gradually we educated ourselves to the needs of the people. 
Gradually the people themselves began to have confidence in the move- 
ment. Big concerns began to take an interest in the work and to see its 
potentialities. Like seed sown on fertile land, the thought spread, and 
is still spreading and blossoming; and is being cared for and nurtured, 
albeit that noxious weeds still try to choke it; but our workers are 
watchful and thorough and the weeds are not allowed to get too strong 
a hold. 

To-day the way is clear to us. We are working on the foundation 
of tested thought and of tested theories. The science of bacteriology is 
at the service of the people. Laboratories are at the service of our Public 
Health Nurses, where tests are made for the immediate detection of infec- 
tious diseases. 

Our foods are tested and must be pure. Compare the milk supplied 
to the public to-day with that of a few years ago. Compare the hen lth 
regulations, both With regard to food-supplies and living conditions. The 
care of health and its preservation is evident everywhere to-day. The 
majority of people study diet and the needs of their bodies. In short, 
they eat to live instead of living to eat. And all this is brought about 
by the health-teaching, and result of foresight, and knowledge put into 
practice by those in authority. 

Our aim and object was as clear to us in the first days as now, that 
of a properly born, healthy generation; but only years of study by those 
who have made it their life's work and hard work by those in the field 
have shown us how that can be accomplished. 

May I quote an excerpt from President Hoover's address at the White 
House Conference on Child Health and Protection? President Hoover 
said: "If we could have but one generation of properly born, trained, 
educated, and healthy children, a thousand other problems of government 
would vanish. We would assure ourselves of healthier minds in more 
vigorous bodies, to direct the energies of our nation to yet greater heights 
of achievement. Moreover, one good community nurse will save a dozen 
future policemen" 

I hate to admit it, but our neighbours across the line are yet ahead 
of us in child-welfare work. President Hoover's address (heard over the 
radio) showed that their Government have realized the fundamental 
foundation of future prosperity — the care and welfare of the child, present 
and future. 

Our own Federal Government has recently undertaken a dental 
survey of the preschool-age child, and the Provincial Department of 
Education is now working in co-operation with the Department of Health 
in a. dental survey of the schools, all of which shows unmistakably that 
the trend of thought to-day is k ' health must come first." Of what use is 

27 



V 



a professional;, scientific, or technical education to a child handicapped by 
physical defects? 

May the day soon come when our Provincial Health Officer will be 
given a free hand, with the backing of the Government, in his efforts to 
ensure a future healthy generation. 

Helen Kelly, R.N., 

Colic ood. 



MISSION AND MAPLE RIDGE. 

Recently I heard a public speaker say, in referring to a part of her 
work : " I never do to-day what I can put off until to-morrow." That is, 
I fear, precisely what I have been doing — putting off from day to day 
and wondering what I shall write about. The time has come when I 
must get busy and write something, but I'm still wondering — 

Last year I had high hopes that January, 1931, at the latest would 
see a nurse in each of the two districts — Maple Ridge and Mission; but 
due, probably, to the niuch-talked-of depression and hard times, I'm still 
spending alternate months in each municipality. Sometimes when I 
read or hear of what some of the other nurses are accomplishing in their 
fields, I really do wonder if I'm making even fair progress. Teachers, 
School Board members, and many others, however, assure me that there 
is a great improvement in attendance, much less of the communicable 
diseases and skin-diseases, and certainly there are fewer of the remediable 
defects than there were when 1 started work here seventeen months ago. 
Of course, in these districts, as in others, there are parents of the type who 
say: " Oh, well ! there was none of this nonsense (health supervision ) when 
I was in school and I'm still alive." Fortunately, however, for the 
children and for the country, persons with that outlook are not plentiful. 

In some of the outlying districts the people see less need of a School 
Nurse. Because of being more or less isolated, there is, of course, less 
likelihood of communicable disease being introduced into the district, and 
there are those who openly resent effort on the part of the nurse or the 
teacher to improve the health habits of the children; especially so when 
greater cleanliness is being stressed. For every one who resents and 
complains there are very many who are appreciative and do not hesitate 
to say so, and that makes the work pleasant and worthy of one's best 
efforts. 

Tact is certainly a necessary requirement for a nurse doing public- 
health work, and heaven help any of us who may not have a very abundant 
supply of that attribute. I wonder if any of the rest of you ever feel as 
I do, at times, that we must almost play deaf, dumb, and blind sometimes 
if we are not going to give some one — perhaps a doctor whom we are 
really anxious to work with, not against — a chance to say we are over- 
stepping — diagnosing, for which Ave are not qualified, or something of the 
sort. I find that about eight times out of ten the parent or the teacher 
can tell me what Jimmy or Susie has. Few parents call in a doctor for 
many of the minor conditions and would doubt the value of a Public 

28 



Health Nurse to the community if she invariably insisted upon one being- 
called for diagnosis. Yet, should these same mild cases go unnamed and 
unreported ? 

Yes! School nursing has its problems all right when working without 
a school doctor. Oh! for the day when health units are well established 
and every district has a full-time Health Officer on whose nice broad 
shoulders can be laid the responsibility. 

The School Hoards and the teachers are all helpful and co-operative. 
Mission Hoard has equipped each of the rural schools with a covered 
water-tank with a tap, individual paper drinking-cups and paper towels. 
These are certainly a great improvement over the open pails which col- 
lected their share of dirt, dust, and germs, and were seldom, if ever, 
thoroughly cleaned, the common drinking-cnp, and perhaps no towel 
at all. 

Maple Ridge Board has fully equipped first-aid cabinets for each 
school. The cabinets were built and painted by the manual-training boys 
under the supervision of Mr. Pattern, their instructor. They contain 
everything necessary for minor treatments. There is still much to be 
desired in the way of facilities and conveniences, especially for some of 
the rural schools, but our School Hoard had a heavy building programme 
last year and has one for this year as well, and it takes courage to ask 
for even the things that we realize are real necessities, not luxuries. 
Hammond now has a fine fully modern six-room school, built during 1930.. 
llaney is to get a new high school this year. In the specifications 
a Medical Inspector's room has been provided for, to the left of the front 
entrance. The Parent-Teachers' Association of Alexander Robinson 
School has had running water put into the school, with basins and a 
drinking-fountain. 

The shields awarded by the Department of Health, Victoria, and the 
local School Hoards were won by Ruskin School, Maple Ridge District, 
and Hatzic School for the Mission District. They were awarded last year 
to the school with the highest percentage of normal weights. This year 
and in the future they are going to the school with the highest percentage 
of children free from any of the following remediable defects: ( 1 ) 10 per 
cent, or more under or 20 per cent, or more above the ideal weight for 
height and age; ('2) defective permanent teeth or unhealthy gum-tissue; 
(.*;') tonsils or adenoids which very evidently require attention; (4) defec- 
tive vision. 

The School Hoard will add the small shield each year, which will 
contain the name of the winning school and (he year. 

We have had a little bil of almost everything in the communicable- 
diseases line this year, but nothing has reached epidemic proportions as 
y^t, unless it is whooping-cough in one of the rural localities. It appar- 
ently got a start amongst the children of a group of mill employees, whose 
homes are closely situated, early in January, and has certainly been 
broadcast in that community. I do not believe a doctor has been con- 
sulted for diagnosis, but several of the mothers whom I have interviewed 
appear to feel quite satisfied that it is whooping-cough, although mild, 
that is so prevalent. On my first visit to the school after the month's 

2!) 



absence from the district, it was necessary to exclude almost half of the 
children because of coryza and coughs. 

We have at present one family in this district quarantined with very 
severe smallpox. There were two families with a mild type of the disease 
before Christinas. The Japanese are exceptionally good in having their 
children protected by vaccination. It is among our own people that we 
find so many who prefer to trust to luck or their vaccinated neighbours 
to protect them and their families against smallpox. 

Through the co-operation of the Provincial Board of Health, a strong- 
effort is going to be made soon to have the very backward children 
examined by a psychiatrist, and to have the very few who are incapable 
of learning excluded from the schools, where they most certainly are a 
hindrance and a handicap to the teachers and other pupils. 

The better-baby clinic, sponsored by the Women's Institute and held 
in the Haney school-house on the afternoon of the local fair in September, 
was a " howling" success. Forty-five babies were examined by Dr. J. R. 
Davies, of Vancouver. Dr. Morse, of Haney, very kindly loaned his baby- 
scales, and his nurse, Mrs. Rogers, assisted with the weighing and measur- 
ing. Mr. Kelsey, the manager of the local bank, donated the score-cards. 
Several of the babies and none of the pre-school-age group were examined 
because of lack of time. Dr. Davies gave an interesting and instructive 
one-hour lecture to the parents. It was our first attempt to hold a baby 
clinic and we felt our efforts were well repaid. We can see plenty of 
room for improvement in arrangements for the next one, though. One 
thing will be an extra room for the doctor, where he will have a quieter 
place lo work and where there will be more privacy for the mothers while 
they dress and undress their babies. 

Mission Fair fell on the same day as the Haney Fair, and Miss Hilda 
Peters came to the rescue, from Chilli wack, lo conduct the health exhibit 
in Mission. In spite of many handicaps, she had a busy day, won a host 
of friends, and had the opportunity of giving a good deal of good advice 
from her store of knowledge. 

Every time I hear of* a prenatal case or a new baby 1 send the name to 
the Provincial Department of Health, so that the mother will receive the 
monthly letters. These seem to be much appreciated in the majority of 
cases, although I too frequently find that the mother has failed to return 
the blue slip sent to her by the Department, so that she will receive the 
postnatal letters. 

The Bygeia, subscribed for by the Department of Health, contains 
so much valuable material that I have started them circulating amongst 
one Women's Institute group and a Parent-Teachers' Association group. 
I really think I should have one for each of my two districts each month, 
don't you? 

I have been asked to give first aid to a group of Boy Scouts; and a 
Canadian Girls in Training group is asking for some talks on home- 
nursing or something else that is interesting. 11 is rather difficult to 
arrange these, satisfactorily to all, when I am here only half-time, but 
1 hope to get started soon. 

30 






Last April Dr. Young spent a day in these districts. He was enter- 
tained at a luncheon given by the Board of Trade, Mission, at which he 
gave a splendid address, followed by another address in the afternoon at 
a meeting sponsored by the Women's Institute, Mission, and still another 
in the Haney theatre in the evening. 

Miss Margaret Kerr, of the University Health Department, gave an 
address on " Adolescent Psychology " to the Haney Parent-Teachers' 
Association in January. It was much enjoyed by all present. I am 
hoping that arrangements can be made to have Miss Kerr address an 
equally well-filled room in Mission some time before the end of this term. 

In July I attended Summer School in Victoria, and took Miss Kerr's 
lectures on health education, home-nursing, and first aid. I feel it was 
a very enjoyable and profitable month. 

I'm talking wk health unit " at every opportunity, and only when these 
are satisfactorily organized throughout the Province will the people see 
what really can be accomplished by organized effort in the way of public 
health and prevention. When we hear more of prosperity and less of 
hard times, no doubt organization of these services will go ahead more 
rapidly. Until then we will have to be content to do what we can to 
convince the people that the country's expenses will really be reduced 
instead of being increased by such measures. 

In closing, I wish to thank all those individuals and organizations 
of my districts who are giving such splendid support and encouragement; 
also Miss Kerr, of the University, and the Misses Peters and Green, of 
Chilliwack, who are always so generous with helpful suggestions and 
advice when it is required. To the two last mentioned, I feel, should go 
much credit for what measure of success the Haney Institute and I had 
with our baby clinic. One of the institute members and myself visited 
their clinic in Chilliwack in August and got many ideas that helped us 
a great deal in making our plans. 

Then there is our Provincial Health Officer, whose interest and encour- 
agement does much toward making this work so pleasant to do. 

H. E. Fawcett, R.N. 



THE KELOWNA RURAL SCHOOLS HEALTH ASSOCIATION. 

A problem that confronts every Public Health Nurse in developing 
her work in widely scattered rural areas is that of combining the various 
local interests into one central organization, so that the work may be 
developed as a whole. I thought that an account of the development of 
our own local organization might be interesting and useful to nurses 
opening up new rural areas. 

Three years ago the Provincial Department of Health appointed a 
Public Health Nurse to assist the district and school Medical Officer to 
develop all phases of public-health work in the Kelowna rural districts, 
an area of 1(H) to 150 square miles, with an estimated population of some 
3,600 adults and 600 school-children, living in twelve small rural com- 
munities, each with its school as the centre of social life. 

31 




The first public meeting addressed by the Provincial Health Officer, 
two weeks after the arrival of the nurse, was neither well attended nor 
enthusiastic. Only six school districts out of the twelve involved seemed 
to wish to try out the hcav health scheme, but nevertheless the nurse was 
instructed by the Provincial Board of Health to carry on the work in all 
the districts as a demonstration of what could be done. 

After three months' work on the districts it became most apparent 
to me that the first step in development must be the organization of a 
representative body from all districts, to arouse local interest and to 
co-ordinate local interests, so that we might have a central organization 
to whom the nurse might bring reports and suggest new methods of 
development of the work. It was also necessary that a central committee 
should be formed, representative of the twelve School Boards, to assess 
the school districts on a pro rata basis of school attendance in order to 
raise funds to carry on the expenses of the new nursing scheme. 

It would have been impossible to develop this idea had it not been 
for the advice and help of a public-spirited citizen, .Mr. E. O. MacGinnis, 
who, because of his enthusiasm for the work, not only used his personal 
influence, but also constituted himself secretary pro tern., writing to all 
the School Hoards and local organizations, inviting them to a meeting in 
Kelowna to discuss both the new service and also methods of financing, 
with a view to forming a central organization representative of all dis- 
tricts to be served by the nursing service. At this meeting Mr. MacGinnis 
acted as chairman and put before the people present in a concise form 
the financial aspect. I gave a very full address, outlining the work done 
in the past three months, ami speaking at length of a possible health 
programme embracing school-nursing, child-welfare, and prenatal care, 
with special reference to the value of preventive work and need of educa- 
tion along health lines. There was a better response at this meeting than 
at the first meeting held three months before, but no real enthusiasm was 
aroused until another general meeting in January, 11)2.'), when a report of 
nine months' nursing service was given. (This report was afterwards 
published by the Department in the Annua] Report for the Province.) In 
the meanwhile many other local organizations had been addressed on 
different aspects of our work, three well-baby and preschool clinics 
organized in different districts, and negotiations were being carried on 
about the possible opening of three more clinics in other districts. 

At this meeting "The Kelowna Rural Schools Health Association" 
came into being, a constitution was drawn up, and an executive elected, 
with Mr. MacGinnis as honorary secretary-treasurer. 

Five months later the executive suggested to the Department that 
they would be willing to provide half the cost of a new car for the 
nursing service. A new Tudor Ford was duly purchased, and inscribed 
on both doors with the words " Kelowna Rural Schools Health Asso- 
ciation. " This inscription has aroused much local interest, and has also 
attracted the attention of out-of-town visitors, who are much interested 
when told about the organization and the health-work carried on in the 
rural districts. 

32 



The Rural Health Association has now paid for the new car, also for 
its upkeep and the general overhead expenses of the nursing service dur- 
ing the past three years. This year the important question of the total 
financing of the service is being considered, which means the undertaking 
of a serious financial burden, which each school district will have to 
decide about for itself. We are hoping that our rural ratepayers will be 
able to finance the work, but there is much local depression owing to 
unsatisfactory fruit-marketing conditions. 

The process of organizing scattered rural areas is always slow, and 

one should not become discouraged if everything does not go smoothly at 

first. Time, and doing the best work of which one is capable, will do 

wonders to convince a somewhat sceptical public of the value our work 

can be to a community. It is very comforting to look back over the 

past three years and consider the truth of the old proverb, " Great oaks 

from little acorns grow.'' . „ ,. T1 , T 

Anne Frances Grixdox, K.N. 



CHILLI WACK-. 



We are at present engaged on a short study of the history of the 
British Empire in connection with our Chapter of the I.O.D.E. This 
makes one feel just now, as the Americans describe it, i4 historically 
minded " and decided me on writing a short history of the work here. As 
in the past, enterprises have been carried on by persons from different 
parts of the world, so in this corner of British Columbia public-health- 
nursing history is being made by Australians. 

For six years a stalwart little group of women of the valley worked 
hard for a Public Health Nurse and struggled against a great deal of 
antagonism. The organizer, sent in to interest the people, described the 
nurse as one who would carry on maternity-work and bedside-nursing as 
well as school and educational work of all kinds. In a municipality of 
this size it was recognized that such a programme could -not be accom- 
plished by one person. Also the women of the valley had worked for 
year's for their splendid little hospital and did not like the implied idea of 
home-nursing in preference to hospital care. 

When at last, in September, 1928, the Government decided to place a 
Public Health Nurse in the municipality as a School Nurse, the work was 
stressed as being of an educational character to begin with. 

Naturally the antagonism shown in any new district continued and 
is only gradually being broken down as the public is being educated to the 
value of the work. 

The group of women, at first composed of representatives from the 
Federated Parent-Teachers' Association, Women's Institute, Red Cross, 
and Municipal I.O.I). E. Chapter, was extended to include a representative 
from each branch of the associations and formed into the auxiliary to the 
Public Health Nurse. Each of these branches gave an annual donation 
to the work of the committee. 

A tremendous amount of help was given to the work by the publicity 
arranged by the Red Cross representative — Mrs. C. A. Barber — through 



the press. Also great interest lias been shown in the work and help given 
to the child-welfare section by the Kinsman Club. 

With the help of the splendid committee the work was gradually 
organized. If assumed tremendous proportions and the calls on Miss 
Green's time and strength were constant. The people, being wide awake, 
lost no opportunity of keeping the work before the different organizations. 
Talks at their meetings were taken for granted from the beginning and 
publicity was carried on. Great help has been obtained from the co- 
operation of the teachers of the valley. 

Miss Green was indeed fortunate in having the one School Board 
only to deal with for the fifteen schools, with school population of 1,050 
to 1,100 children. With her enthusiasm and their wise co-operation, im- 
provements were at once made in unhygienic conditions existing in the 
buildings. Constant attendance at the monthly meetings kept up the 
interest, and at the end of term arranged for by the Provincial Board of 
Health her services were continued with great satisfaction. 

A clinic-room, to act also as city office for Miss Green, was arranged 
for' by the Kinsman (Tub in the spring of 1929 and baby clinics attended 
by local doctors were started. This work was also extended to include a 
clinic programme at the Fall Fair. This took the form of a baby and 
preschool clinic, with specialist, in attendance and an educational ex- 
hibition of literature, etc. A rest-room and creche were also arranged 
for. In the Fair arrangements this now has its place as an animal 
contribution. 

In the summer of 1929 some thirty to forty tonsillectomies were per- 
formed on children of the valley, being more than had ever been known 
before. 

In the first year the great need of eye-work was realized and in the 
fall of 1929 an eye clinic was organized, with a visiting specialist. Dr. 
Hopkins, of New Westminster, attending. The work was sponsored by 
the committee and Municipal School Board, a reduced fee thus being 
possible for glasses of school-children, the Government assisting with 
indigent cases. This clinic has been used to such an extent that the fall 
and spring series of weekly visits Avas found inadequate and a monthly 
or bi-monthly visit is now paid as needed. 

Co-operation with Dr. Lamb gradually extended the services of his 
department until at the fall clinic of 1980 eighty-six patients were 
examined. 

The great need of help with the dental work was constantly being- 
realized. The dentists were contacted and finally in the spring of 1930 a 
survey made, which showed (he need in the country schools to be 
tremendous. 

During this time First-aid and Little Mothers 1 League classes were 
not neglected and calls from the city were constantly being made on Miss 
Green. The city public and high schools were not touched by the Mu- 
nicipal Nurse, and city help was not really supposed to be given. 

In September, 1930, the Government decided to send in a City Nurse 
on a six-months' demonstration. I was appointed and the work thus 

34 



linked up. With all the previous contacting, my arrival created very 
little sensation. Parents, now being used to the idea, welcomed the ser- 
vices of a School Nurse. In fact, some had been a little jealous of the 
municipality. 

The fall eye clinic showed the great need of the extension of the work 
to the city schools. Help with the chest clinic was given and the child- 
welfare work taken up. 

During the last two and a half years the Mennonite settlement lias 
been growing rapidly. The school population, which is now 150, was in 
1928 ten to twelve children. Here there is a great held for work as the 
people are open-minded and grateful for help. Looking after them alone, 
with their various problems, could easily take up one-half of a nurse's 
time. 

During this fall and winter our efforts have been bent on seeing the 
fulfilment of the dental-clinic scheme. Government help has been 
promised and another survey of school-children of the municipality made. 
Meetings have been held with the four dentists and at first a representa- 
tive from the Municipal School Board and more recently one from the 
City School Board. Every disadvantage has been brought up — whoever 
would have thought there would be so many? At present the matter is 
standing over until the dental campaign of March opens up the way. 

Between fifty and sixty tonsillectomies were performed in the last 
year. In this valley, with its damp climate, the throat, nose, and ear 
conditions are especially noticeable. Our great difficulty in regard to 
this is the people who cannot pay the required fee for operation. Help 
can be obtained for indigents, and for the comfortably-off parents nothing 
is needed but acknowledgment of the necessity. For the majority of the 
population there is a crying need for a nose and throat clinic with 
reduced rates. 

In my city work there has been a great deal of teaching of hygiene, 
both in high and public schools, also a Little Mothers' League class for 
Grade VIII. girls. In the City Canadian Girls in Training I am about 
to start a first-aid course with thirty-five girls. This is all a very inter- 
esting experience. 

Every epidemic shows anew the tremendous need of a full-time 

Health Officer. This is especially noticeable with the ever-increasing 

foreign population of the country. We look forward to the day when the 

valley contains a complete health unit, when wonderful work should be 

accomplished. TT 7> -p, a . 

1 Hilda Peters, R.N. 



THE OSOYOOS, TESTALTNDA, OLIVER, FAIRVIEW, 
AND FALLS DISTRICTS. 

The second year of the Osoyoos, Testalinda, Oliver, Fairview, and 
Falls Districts is past, and while only a small beginning has been made 
in the work her'e, we are pleased to note that the children, parents, and 
community are becoming more alive to health-work. The school-work has 
been most interesting, there being one outstanding and enterprising event. 

35 






Last year Major Fraser, of Okanagan Falls, who is keenly interested 
in health-work, donated a cup in order to stimulate interest in the school- 
children of the districts in the need and value of health. There is to be 
a yearly inter-school health contest, the successful school holding the cup 
for one year. 

After suggestions for points to be used in this contest were drawn 
up a conference was held with teachers from all the schools and the nurse. 
At this conference every one took part in the discussion, and finally the 
points with details were decided upon. 

(1.) The health chores to be kept for five or ten weeks (all grades). 

(2.) Health posters or booklets: Grades I. and II., health rules illus- 
trated; Grades III. and IA"., healthful foods; Grades V. and VI., a day 
in the life of a healthy girl or boy; Grades VII. and VIII., balanced 
meals. 

(3.) Weights: Percentage of normal weights; percentage of gain in 
underweights. 

(4.) School lunches. 

(5.) Conditions of buildings and playgr'ounds as related to health. 

(G.) Attitude of school-teacher and children towards health. 
Teacher: Reporting sickness, ventilation, lighting, and attention to health 
matters. Children: Personal cleanliness, etc. 

Towards the end of the school-year two outside nurses with one 
member of the community examined the health posters, and these nurses 
also inspected equipment, sanitary conditions of schools and playgrounds. 

The nurse of the districts checked up the percentage of normal 
weights, gains by the underweights ; the teachers with regard to reporting 
of sickness, the ventilation of school-room, and care of lunches, also the 
children with regard to cleanliness. 

As the school-year drew near its close one could see that the rivalry 
for first place lay between the Falls and Fairview Schools. At the last 
the Falls School led by a small majority. 

At a public meeting at the Falls Mrs. R. Simpson, of Testalinda, pre- 
sented the Fraser health cup to the senior girl of the winning school. 

While great interest was taken in this contest by the pupils, teachers, 
and parents, the competition this year' is and will be far, far keener. 

There have been some slight changes made in the points this year. 

Point 1. Grades I. to IV., the health chores to be judged by the 
teacher (daily inspection) ; Grades V. to VIII., the health-chore forms 
as supplied by the Department of Health. 

Point 2. Health posters : Grades I. to IV., health chore which is 
found by inspection to be most necessary; Grades V. and VI., fresh air 
and disease-control. 

Point 3. School lunches have been eliminated. 

We are looking forward to the work of the future and hope that as 
the work develops it will be strong in all its branches, for we realize 
" That a chain is as strong as its weakest link." 

G. M. KlTTERINGHAM, R.N. 
36 






SCHOOL-WORK IN NANAIMO. 

In the short time which I have spent doing school-nursing and health- 
teaching in Nanaimo it remains for me to give only my impressions of the 
attitude of the people toward my work, and to say of what my work 
consists. Under the following headings I shall try to offer my opinion 
and suggestions : — 

Personnel. — One part-time Medical Officer; one full-time Health 
Nurse; pupils enrolled, 1,300 to 1,400. 

Routine of Work. — In the four preliminary schools a monthly inspec- 
tion is made to determine the general cleanliness of the children, to dis- 
cover skin eruptions and symptoms of infectious disease, and to check up 
on defects reported and remedied. A yearly examination is made of ears 
and eyes. Every month the underweight children and those requiring care- 
ful watching are weighed. Each school is visited twice a week, absentees 
reported, lavatories and wash-rooms inspected, and visits made where 
advisable and when possible. 

Follow-up Work. — This branch of my work I feel is sadly neglected, 
to the detriment of many things. The home visit is the Fublic Health 
Nurse's best channel through which she may carry to the parents of 
Nanaimo her motive for being in the schools at all. Defects found and 
followed by a visit may be remedied far more speedily and intelligently 
than those followed by a note or telephone call. Many misunderstandings 
exist between parent and School Nurse; one of the most destructive to 
our work being that the nurse is in the school for the sole purpose of 
sending the pupil home on account of illness. If the parent never sees 
the School Nurse, is it to be wondered at that such is the point of view of 
many? This condition we hope may be remedied in the near' future if a 
car can be put at the disposal of the nurse. 

Health Education. — Following each monthly inspection I have given 
a health talk to the class — in the lower grades trying to stress the im- 
portance of keeping the health rules. Tn the upper grades I have tried to 
teach the children where their responsibility lies in guarding health and 
the importance of physical examinations. In some classes the health 
report sent home for each child has been discussed with the pupil. Much 
interest is being shown in these, and an effort to change a " B r to an 
" .V " comes from the children themselves. 

This year in the -Junior High School "child care'- is a part of the 
regular curriculum. The home-economics teacher and I have co-operated 
in this case, and to seventy-five girls have been given eight lectures, with 
demonstration in the elements of child care; prevention all through has 
been stressed. Already the girls are showing signs of jacking up their 
parents to take their baby to be weighed every week. 

Co-operation with Agencies. — In all the schools improvements are to 
be made in the wash-rooms and in the lighting of some of the elementary 
schools. This is the result of a report submitted to the School Board, in 
which it was pointed out how essential were good lighting and proper 
washing facilities if the health of the children is to be guarded. We hope, 
too, very soon to co-oper'ate with the Parent-Teachers' Association to pro- 

37 



vide lunch, a hot drink of cocoa or soup. The I.O.D.E. already provide 
ten children who are below par with milk daily. They have also in one or 
two cases provided cod-liver oil for these children. The School Board of 
Trustees have been most co-operative and have been helpful in supporting 
any project which has been suggested and which may help forward the 
health education among the school-children. 

Our Aim. — The need for greater education among the adult popula- 
tion shows itself daily, and our next hope is that group teaching may be 
established among some of our mothers. The dental work of the school- 
children is also a problem that calls for our' attention. Some work in this 
direction is also under way. Our greatest hope, however, is that Nanaimo 
may soon possess, like Saanich and others, a health unit. This would not 
solve all our problems, but it would be a stimulus for all those engaged in 
and interested in health-work here to put forward fresh effort. 

M. Dorothea MacDermot, R.N. 



NEW DEVELOPMENTS IN THE KELOYVNA CITY SCHOOLS. 

The work of the Health Promotion Department of the Kelowna 
schools has been concentrated this year on immunization and health- 
teaching. In the health-teaching work some rather drastic changes have 
been made, the most important being the transferring of the actual teach- 
ing from the nurse to the teacher. Whether this is a change for the better 
is a debatable question. The change was really made more or less as an 
experiment, since it was obvious that the policy of last year was not alto- 
gether satisfactory. This policy left most of the health-teaching to the 
nurse and allowed her fifteen minutes a week in each class-room from 
Grades I. to VI., inclusive. This made the subject too much of an isolated 
one and really did not allow sufficient time for covering the desired 
teachings. The time spent by the nurse, not only in the actual teaching, 
but also in the preparation-work, amounted to a great deal. It was felt 
that this time could be much more profitably spent in home-school visiting. 

Accordingly, the change was made and this year the teachers, under 
the guidance of the nurse, are doing the health-education work. A definite 
check-up of the results, beneficial and otherwise, is to be made shortly. 
This will include not only the pupils' reactions, but also the influence, if 
any, in the homes. It will be interesting to see just what these results 
will be. 

The baby clinics were reopened last spring, with Dr. Ootmar in 
charge. Since then the total number of babies registered has more than 
doubled, a fact which is most gratifying to those undertaking this work, 
which is proving such a boon to the mothers of the town. 

A new undertaking this year has been the establishment of a Save 
the Eye Fund. This has been made possible through the generous work 
of a small group of local ladies, who raised the necessary money by holding 
bazaars, garden parties, etc. A clinic is now being arranged for those 

38 



indigent children in need of glasses. Just what this will mean to such 
children is needless to explain. 

The plans for a hot drink at noon for those children who bring their 
lunch have become almost a reality. A suitable room has been secured 
and outfitted by the School Board. Local service clubs have been ap- 
proached, with the result that contributions have been offered, financial 
and otherwise, for this undertaking. We are counting on providing this 
hot drink to some 125 children. 

One often wonders at the end of a day's work just how well worth 
while is this School Nurse's job of keeping the children well. The answer 
to this question is found in the old Arabian proverb, " He who has health 
has hope and he that has hope has everything! " 

Edith W. Tisdall, R.N. 



THE PRESCHOOL VISIT. 

The proper care of the preschool child bears the same relation to the 
school-child as prenatal care bears to the infant. Having passed through 
the dangers of infancy with the protection against environment afforded 
by his mother's milk, the child is suddenly forced to face new dangers 
and a wider environment, dependent upon his increased activities. This 
age between 2 and (> might well be called the awkward age, an age when 
both child and mother must get their bearings, as oftentimes there is a 
new baby in the home and the pre-school child is relegated to a position 
of unimportance. This adjustment can, to a great many, only be brought 
about by the visits and information from the nurses regarding character- 
building, diet, and hygiene. 

The parents should be taught that character' is made up of experi- 
ences, and experiences are due to environment. If the right environment 
is not given, it does not give the child a chance to realize his potentialities. 
The nurse, while making a visit, can suggest many ways of creating the 
right environment for the child, such as proper contacts, home surround- 
ings, and thought given to the child's recreation, and training it to forego 
its infantile habits and to face the growing-up period with the right ideas. 

Of equal importance is the physical development of the child. The 
nurse conies into the homes to advise and help in the care of the children's 
diet and personal hygiene and to relieve critical situations. In many 
c:ises physical defects are overlooked till the child enters school. Early 
treatment is undoubtedly more effectual. In many cases, too, even though 
the defects are noticed, they are often neglected through ignorance and 
lack of understanding. The parent should be made to realize the im- 
portance of early correction of defective teeth and tonsils and of bringing 
the child to clinic for thorough examination. 

To prove the value of immunization and vaccination is sometimes a 
difficult problem, but this can be overcome in a great many cases by 
educating the parents and making them understand that young children 
have much less resistance to contagious and infections diseases than older 






children and adults, and oftentimes they may become impressed with the 
seriousness of contagious and infectious diseases and their complications. 

A simpler problem is that of making the parent realize the value of 
proper diet. The many advertisements, magazine articles, and posters 
help the nurse in her work. As a rule the parents will take kindly to such 
suggestions as giving the child the proper amount of milk, green vege- 
tables, cod-liver oil, etc., including a well-balanced diet and regularity 
regarding meals. 

And so we gather that the pre-school visit is as much for the parent as 
the child, and the parents should realize they must play the health game 
as squarely as possible with the children ; and that the essential matter is 
that the child of the pre-school period has definite needs and rights which 
must be met, and it is only by the co-operation of the parents with the 
health teachers that the health of the pre-school child can be established. 

C. Rose, R.X., 

Saanich Health Centre. 



PORT ALBERXI. 



The growth of the infant-welfare part of public-health work in a 
district is one of the most interesting and encouraging parts of a gen- 
eralized programme. Except for the equally important prenatal service, 
one cannot begin earlier with those individuals, which is perhaps the chief 
cause for any unusual interest. 

Two years ago in this district there was a great deal of perplexity 
in regard to the reasons for and the aim of a well-baby clinic. The 
popular opinion was that it was some form of baby-show. Some thought 
it was for sick infants, and such remarks would be made frequently as, 
" My baby is all right so there is no need to take him to a clinic," or 
" When my baby gets sick I will take him to a doctor." Also, some 
mothers objected to taking their children where there were so many 
others, partly through fear of infection and partly through reticence. 

This year, while there are still some who have never attended the 
clinics, a few through indifference or objections, a few through not being 
able to get there, there have been occasions when a mother has hired a 
taxi to bring her baby. There has been a steady increase to the registry 
and the fortnightly attendance, 134 being on the record now. With but 
one exception there has always been at least one " new " baby attend each 
clinic, and sometimes several. The numbers recently have been from 
thirty-one to thirty-six. Some of the mothers are so keen about their 
infant's growth it would take a bad storm to keep them away. Another 
satisfaction is that there is little or no class feeling; the most fortunate 
as well as the least fortunate baby comes. The mother's appear to be 
much interested in each other's babes. 

These well-baby clinics do not obviate the necessity for home visits, 
as there is seldom time in the crowded room to discuss all the points of 
mixing of formulas, clothing materials, patterns, etc. Also the doctor's 
advice frequently has to be stressed again and again, as well as inter- 

40 



preted at times. Few homes are equipped alike, and in one of the poorer 
kind you have to advise differently than you do in one that is better 
financed. 

There is some difference, too, in the general public's attitude toward 
the work. The majority of them were very vague at first as to its mean- 
ing, and not wholly agreeable. The articles in the press about the service, 
as well as the satisfaction of some of the patrons, are responsible for part 
of the change. We are seldom asked now what we " do " to the babies 
at the clinics. Nor is surprise expressed as often when we say that there 
had been thirty-some babies at one clinic. The more frequent remark now 
is : " I knew it was clinic day because the town was swarming with baby- 
carriages.'' 

The endeavour on the part of one of the City Councillors to obtain a 
small room in the City Hall for an office for the public-health service 
resulted in a larger office in a business block, the rent to be paid from the 
city's funds. The majority of the Council stated that they considered the 
work worth}' of that support. The office is large enough to accommodate 
the clinics. 

The local doctors have been very good indeed in their attendance. 
We have held only one clinic without one of them present. Their support 
and interest has been largely responsible for the degree of success there 

lias been. tit t^ ^ n -vr 

Mary E. Grierson, R.N. 



NANA! MO. 



I believe that it has been said that this district is a marked example 
of the lack of a public-health conscience; this was in l!)2i); but perhaps 
this is not any worse than in most districts. Now in 1931 I think that 
we can truthfully say that this has improved slightly. One still hears 
frequently, and much too frequently, that " Kill might as well get 
measles, and have it over with now"; or that " Baby eats everything— 
she has a wonderful stomach! She can take anything.'" But occasionally 
and more often than before mother guards her son against whooping- 
cough, because of after-effects, and she follows a more careful diet for 
baby to assure good health and teeth in maturity. 

Unfortunately, our weekly well-baby clinic has no physician in 
attendance and is just a weighing-station, but in spite of this handicap 
the average attendance has increased considerably during the past year, 
which is encouraging. Here defects are noticed and the mother is told 
to consult her family physician. The mothers are asking more and more 
questions concerning correct diets and the baby's routine. II is very 
encouraging when a mother says to you : " I wish I had had this help with 
my other children, she has been so good." It is these little things that 
encourage one to carry on. 

The prenatal work has increased too, in that more prenatal visits 
were given to mothers who were going to hospital or nursing homes for 
the confinement. More frequently a mother asks me to visit her friend 
who is expecting a baby. 

41 



This year more T.I>. contacts have been found, and examined by 
J)i\ Lamb, and, in the odd case, an incipient case was found, thereby 
receiving treatment before it was too late and when there is all chances 
of recovery. Dr. Lamb this spiring made a special visit to take care of 
the contact s. 

This is the second winter for home-nursing classes, which show an 
increase in attendance, especially among the mothers and 'teen-age girls. 
Through these classes the members learn the prevention of communicable 
disease, importance of prenatal care, care of the baby, and diet from 
babyhood to old age, as well as the simple nursing procedures. 

Through teaching health in the homes, clinics, and classes, one sees, 
year by year, greater interest shown by the public and a more hearty 
reception of onr programme. 

Muriel Upshall, R.N. 



OXVYAK1). 



Those who saw the recent motion picture. " The Big Trail," could not 
help but be impressed with the earnest and plucky determination the 
ambitions trail-breakers displayed. In spite of the many obstacles and 
trials which presented themselves, the pioneers kept bravely on their way 
until their goal was reached. 

While I was viewing this picture, the thought that we, as Public 
Health Nurses, can readily be compared with the pioneers passed through 
my mind. That idea is old, 1 know, but since 1 have been practising 
public health for two years 1 have found that the upward grade seems 
to be very steep at times and that keeping out of ruts is a problem. 

In her book, " Public Health Nursing," .Miss Mary Gardner states 
that one of the important things for a Public Health Nurse to remember 
is to keep tit physically. In fact, this point is wisely stressed by many 
authorities. The necessity of keeping tit mentally is, in my opinion, of 
equal importance. It becomes a very easy thing for the nurse to consider 
her day's work as so many tasks and duties to perform, or as so many 
homes and schools to visit. 

This would seemingly apply more to the nurse working alone in a 
rural community. Not often does she come in contact with those inter- 
ested in the public-health questions of the day. She alone stands as a 
real pioueer in the work — a link between public health and her com- 
munity. Consequently, her problem is to not become discouraged when 
the way seems hard and rough, but to keep on constantly looking ahead. 

Public Health Nurses working together, although having the advan- 
tage of association with those who have chosen the same profession, have 
similar problems. Although the stronger ones are able to help the weaker 
ones along, it is very easv for them all to drift into the same mental 
attitude, and the idea of the aim for which they are striving is lost. 

It is most encouraging to watch the work in British Columbia going 
ahead so rapidly, however, and when each of us remembers that we are 

42 




all pioneers in the service, and that we are not working alone in onr tasks, 
we should find it more easy to keep a bright outlook as the days go by. 

Myrtle E. Harvey, R.N., 

tfaaitich //ralth Centre. 



HEALTH NEWS FROM KAMLOOPS. 

After writing so many articles for our Nurses' Bulletin it is diffi- 
cult to find something new about which to write. One thing we are 
rather proud to talk about this year is the forming of our Dental and 
Medical Fund for our schools. We have many children here with defects, 
but the parents find it impossible to have these attended to. 

The thought came to me that our little Junior. Red Cross members 
would like to find funds for this purpose. We held a Junior Red Cross 
Primrose Tag Day in April, 1930. It was a great success. The children 
were so happy living their motto for that day, " I serve." They looked 
so sweet in their caps and aprons and entirely charmed the public. They 
collected $186. At the end of the day they were very happy little Juniors. 

We formed an advisory committee consisting of six interested people 
of our town. This committee manages the finance and helps me to decide 
on questions regarding the parents that need the greatest assistance. 
They are a great help to me and ever willing to give me the advice that 
I need. My committee appealed to the various organizations of the town 
for contributions towards our fund. We were given $65; that makes a 
total of $2:51. Already eighteen children have benefited from this fund 
and we expect in the near future to have about twenty-eight more assisted. 
We intend to adopt the same method this coming April for the same 
purpose. 

This year I have examined with great care the feet and posture of the 
children. I have found many defective in this way, especially junior 
and senior high-school girls. A great deal of education is necessary to 
make these girls and their mothers realize the grave dangers of the wrong- 
shaped shoes that they persist in wearing. With the help of our physical- 
culture instructors we are giving these girls and boys special exercises. 
Already we are finding improvement. 

Little Mothers' League classes were given to the Oirl Guides last year 
and this year. I am giving more advanced lessons to the Rangers. This 
part of my work always gives me great pleasure and I realize the great 
necessity of training these girls for the greatest gift of life, "mother- 
hood.'' I look forward with the assurance that our future mothers will 
be better prepared for taking up their responsibilities-. The splendid work 
of the Girl Guides and Canadian Girls in Training will surely bear its 
good fruits in the near future. If only we could get the young mothers 
of to-day to realize what we Public Health Nurses have to offer, I am 
convinced we would not have the high infant and maternal mortality 
which so alarms the thinking people of all countries. 

Olive M. (iaukood, B.N. 
43 



A DAY AT BAMBEKTON. 

So much has been said in the Bulletin about health measures, modes, 
and methods that I feel inclined to digress and give you a glimpse of a 
day in the most unique village of my acquaintance, which I visit once a 
month on my rounds from the Health Centre. 

Shall we start from Duncan by way of the drab but interesting Indian 
village, which we must perforce go through in order to start the long- 
journey before us? 

Here is Koksilah, not much to look at, and the road reminds one of 
a roller-coaster, but we soon come to Cowichan Bay, where the sea rolls 
on serenely beside the r'oad, backed with mountains and mountains of the 
most gorgeous hues; they look so peaceful. However, we mustn't stop 
to dream here because we have a busy day ahead of us. 

This little place is Cobble Hill (wonder where the name originated?) 
and farther on is Mill Bay, a lovely resort in the summer-time. That 
road? Oh, that's the road to the Solarium; I must take you there some 
day. You'd be very interested in a visit to that institution. 

Now we start to climb the Malahat, up and up, for miles, and we 
wonder when we will ever reach the top, when suddenly, around a bend in 
the road, we are confronted with a finger-post directing us to Bamberton 
— 'left turn, and a 90° turn brings before our wondering gaze a steep 
incline which calls for caution of itself, despite the warning sign which 
informs us that there are children in the village below. 

In a hollow below us we see the school, surrounded bv dustv shrubs 
and an equally dusty stone wall, and ever in the distance that fascinating 
panorama of sea and mountains. Continuing the steep descent, we see 
r'ows of houses on different levels resembling huge steps, most of them, 
especially the newer ones, built of cement and stucco. Interesting bunga- 
lows they are too, surrounded by gardens all grey with dust, which, 
strangely enough, produce the most amazing assortment of flowers in the 
summer-time — even while one is wondering how they manage to survive 
and whether the housewives ever get through their dusting! (Somehow 
the idea occurs to us that this must be a fertile place for T.B.) 

We must pop into the school ; it is a homy little place and houses 
about twenty-six of the liveliest j^oungsters you ever saAV, who are almost 
100 per cent, healthy. We unconsciously wonder at this, somehow, 
because of all the dust. 

After the monthly examination and the short health talk, we start 
for the Ford, and proceed to coast down the hill a little farther to the 
Community Kecreation Hall, which has been built by the company. In a 
little while the youngest members of the community appear to be weighed. 
Here they come in lovely English perambulator's, spotlessly clean, all 
about the same age, looking as happy as the day is long. We find that, as 
usual, they have gained from 1 to iy 2 lb. since they were weighed last 
month, and we commend them for their choice of up-to-the-minute mothers 
who are bringing them up in the way they should go. 

44 



Now we must take a trip to the youngest member of the community, 
whose mother has not been able, so far, to make the steep ascent to the 
hall to have him weighed. She lives at the bottom of the quarry, which 
means a trip by hoist, which also means a little excitement. We set out 
to find the engineer and to inveigle him into running the hoist on a special 
trip for us. He being a gentleman, and we being the accepted nurses for 
their little village, the trip is managed, because he knows the newcomer, 
as does every one else, and he is glad that we are going to pay him a visit. 
While we are waiting for the hoist to be brought up for us, Mr. Engineer 
asks us if we have seen the cement-kilns in operation. Our answer being 
in the negative, we are piloted part way down the steep hill and guided to 
huge sheds containing three immense cylindrical drums, about half a 
block long, which incessantly revolve and roar. A pair of darkened 
glasses are handed to us, and we peep through a hole in the first drum, 
to behold a seething mass of something which we assume to be cement in 
the making, at a white heat, constantly rolling about. The thought 
strikes us that any one who had the misfortune to come into close contact 
with that would soon be roasted beyond recognition. Getting out of that 
place was somehow a relief, even though the engineer assured us that 
nothing had happened to date. 

Here comes the hoist, and board it we must, though it looks a very 
forbidding apparatus, only a large platform, with no railing, which is 
pulled up and lowered by means of a cable! We brace our feet and our- 
selves for the descent, feeling quite squeamish about it, and are horrified 
to feel the thing move steadily down the hill. We become almost panicky! 
Suppose the cable should snap in two! Heavens, we are heading for the 
open sea 'way 'way down below us! If we could only sit down, but we 
haven't brought our supply of newspapers, and the floor of the hoist is 
much too dirty. Oh, well, it can't last for ever; and trying to prove to 
each other that we are as hard as nails we comment on the scenery, and 
admire the huge machine-houses we are passing, and view with no little 
interest and longing that old landing-platform below, while a little joy 
creeps into our voices as we get closer to it. 

Quite safely, to our amazement and relief, we arrive, wave our hands 
to the man up above, who was responsible for our descent, to assure him 
that all's well, and start off on a beautiful walk to find the baby of our 
quest. The dinner-bell sounds, and soon we see men, all types, hurrying 
from all directions to the one big cook-house for lunch, amidst the rattle 
of dishes and pots. We feel hungry too! 

Along the winding paths, amongst the most beautiful surroundings, 
up steps — dozens of them — and along another footpath, then more and 
steeper steps, and finally we reach our destination, and view with pride a 
bonny, happy baby. (Funny that we should suddenly realize why his 
mother hadn't been to the clinic before; even when used to it, that hoist 
must take a certain amount of courage to tackle!) Mother is so glad to 
see us, and asks us heaps of questions about the care of her newest off- 
spring and whether we approve of him. She serves us tea and toast in 
lieu of lunch, for which we haven't time, as the hoist returns in twenty 
minutes, and again we start off. 

45 



The return journey is not so bad. There are two trucks of gypsum on 
the hoist this time, and we have something to hang on to, while the sea is 
at the back of us; and what we don't see, evidently doesn't bother us! 

The little Ford looks good to us by this time, and we speed up that hill 
in haste, glad to see the highway and to feel on firmer ground, though it 
isn't any sounder than in the village we have just left behind us. 

Discussing the pros and cons of all the dust we found, the idea 
occurs to us that, perhaps since the cement is so thoroughly sterilized in 
the process of being made and all edges rounded off, the particles which 
enter the lungs do no harm, but that, being lime, are absorbed into the 
system, resulting in benefit rather than harm, which accounts for the 
general well-being of the community. 

Velma Miller, K.X., 
Cowichan Health Centre, Duncan. 



MY DISTRICT WORK, PAST AND PRESENT. 

Well-nigh ten years have passed since I was first appointed as District 
Nurse in Sayward, although prior to that I had on many occasions been 
called upon to assist, in times of need, settlers and loggers in this vicinity. 
I, as a qualified nurse, was sought in cases of emergency, and felt glad on 
those occasions that I was able to lend my assistance to those so sorely 
in need. But upon being officially appointed I discovered the unpleasant 
fact that many of the settlers did not look upon my work at all favourably. 
This was especially true in regard to the supervision of the school-children, 
the installing of sanitary appliances and improvements in the little build- 
ings. However, there is nothing like perseverance to win a cause; now 
the schools are equipped with water-filters (which were most decidedly 
needed), individual drinking-cups, medicine-chests, and proper sanitary 
outhouses. Last, but not least, I have won the co-operation of parents 
and School Boards. 

This district is still very much in the pioneering state, being isolated 
by the lack of road connection with the rest of the island. Only the 
bi-weekly visit of a Union steamship keeps this scattered district in touch 
with the outer world. Therefore very few changes have taken place in my 
ten years of service. 

For the past four years Dr. Youlden, dentist, has been sent in by the 
Provincial Board of Health and attends the schoolchildren and tiny tots. 
This in itself is a great boon to the settlers. Dr. Moore preceded Dr. 
Youlden for two years. 

For the past five years the Coast Mission ship " Columbia " has 
carried a doctor on board. They touch in here about every two weeks, 
and on very urgent occasions can be reached by wireless. Co-operation 
with the Mission workers is a great help in serious and hospital cases. 
One case in particular I well remember; it was when a miner was badly 
mangled by an ex r plosion. Three days after the accident, which took place 
far up in the hills, the " Columbia " docked at Alert Bay and our patient 

46 



was removed to the Mission hospital, where he was immediately operated 
upon. But unfortunately help of this kind cannot he always at hand and 
we must make the best of things and do the best we can. 

The prenatal work is carried on as far' as possible, and I must add a 
word in praise of the postnatal letters, which are certainly most helpful 
to young mothers in isolated places. 

Two years ago a little cemetery was opened in Sayward, in which 
there now lie five occupants. It is one of my duties as District Nurse to 
lay out the corpse. 

In summing up my work, it is this: Prenatal work; bringing into 
this world little lives; care of children and their various ailments; acci- 
dents; sickness; and, last of all, watching through the long hours of the 
night as the grim reaper takes his toll. 

There is likely to be much development going on in Sayward during 
the coming years, as a very large logging camp is making arrangements 
to start operations in the valley. This will make a great deal of activity 
in the district and serve to bring in more settlers, which will add consider- 
ably to the range of work in this district. 

Edith M. Walls, R.N., 

Saijicarrf. 



VERNON CONSOLIDATED SCHOOL DISTRICT. 

Comparisons are rather difficult, so this year I am going over a part 
of my work for the past year. 

In addition to the health classes which I take each week in the 
schools, I also have Little Mothers' League and home-nursing classes. We 
received a nice new Chase doll and bed for this work; the doll was given 
by the School Board and the bed, bedding, clothes, etc., were donated by 
one of the " Little Mothers." 

Dr. Lamb, Travelling Medical Health Officer, visited this district twice 
during the past year; twenty school-children attended these clinics. No 
real trouble was found among them, although some of them require special 
care ; a rest period is given them each day and cod-liver oil is provided 
for them. 

We have held dental clinics each school month, sixty-two indigent 
cases being treated during the year. The interest in care of the teeth is 
increasing, and I note with great satisfaction that frequent visits to the 
dentist are becoming more of a habit with the children. We are busy 
now arranging a programme for the B.C. mouth-health educational cam- 
paign in this district. More attention also is being paid to the removal 
of tonsils. 

A baby clinic was held in October and a pre-school and well-baby 
clinic is to be held in May or June this year. 

Preparations were made last fall to vaccinate the school-children, 
but owing to an outbreak of scarlet fever the preparations were delayed. 
We are now making arrangements to vaccinate the school-children during 
the week preceding the Easter holidays. 

47 



Our scarlet-fever outbreak has resulted in the following number of 
school cases: December, 2; January, 13; February, so far, 10. I hope 
it is nearly over. Scarlet-fever serum was used in Januarv, but not to 
any great extent. 

One of our greatest problems seems to be the teaching of proper habits 
of healthy living to these new Canadians who are pouring into our district. 

In conclusion, I must say that I enjoy working among the children 
the best of all. 

Elizabeth E. Martin, R.N. 



REVELSTOKE— A NEW SERVICE. 

The wisdom of having a School Nurse has been a much-debated topic 
in Revelstoke for some years. The School Board of 1930 decided they 
would give the service a trial for four months. This was strongly urged 
by the principals of both public and high schools. 

In September, 1930, I started work here with a feeling that I had 
strong opposition against me, for the School Board were only partly in 
favour of it. The teachers did not know anything about the service and 
some of the leading merchants thought it was a waste of money, especially 
in these hard times. 

After a visit to the Medical Health Officer, who is also the school 
doctor, I felt better, for he seemed to be a man keen on prevention, and 
he assured me he was behind me in whatever I did and that he was very 
glad the service was being given a trial. After I was here a conple of 
weeks the School Board asked me to come to their meeting and explain 
the service to them ; the Kotarians asked me to speak at their luncheon, 
also the Canadian Club asked me to address their meeting on school- 
nnrsing. 

In November the School Board informed me they were very pleased 
with the service so far and that they had decided to keep it on for a year. 
This year, when they were making up their estimates for the coming year, 
they came to the conclusion the service was beneficial to the community. 
So they are keeping it on. 

Skin conditions were very prevalent all autumn and winter. I have 
been doing class-room inspection twice a month, and I am very proud this 
month, for I have not seen a case of scabies and only one of ringworm. 
But I am watching the schools very closely, for we have three households 
quarantined for scarlet fever in town and we are hoping there will not 
be any more. 

When 1 came back after the Christmas holidays, on the first day of 
school many of the children came up to my office to tell me they had 
received manicuring-sets for Christmas and now they were going to try 
and keep their nails nice. 

There are about 750 children attending school, of whom 150 are in 
the high school. I take two classes in first aid at one public school and two 
classes of home-nursing at the other public school, and give a forty-five- 

48 



minute health talk in each of the five classes in the high school every month. 
It seems to me other nurses accomplish a great deal more than I do, for 
I have hardly touched on child-welfare or pre-school work, but I do feel 
the work is being established here, and I hope before another year we 
may have a dental clinic in connection with the schools. 

I cannot speak too highly of the co-operation I have received from 
the teachers of both public and high schools. They have made my work 
a pleasure to me, and most assuredly have been responsible for the success 
of the work here so far. I also wish to thank the Provincial Board of 
Health for its encouraging letters and for endowing us with the feeling 
that they are always ready to back us up. 

A. my A. Lee, R.N. 



THE NORTH VANCOUVER HEALTH UNIT. 

The North Vancouver Health Unit is the fifth of its kind to be estab- 
lished in British Columbia, and as such it may be of interest to others to 
read an account of the unit and its activities. 

A health unit is a complete modern health department for two, three, 
or more municipalities, thus making it possible for rural as well as small 
urban communities to have the advantage of modern preventive medicine. 

The financial and business affairs of the Health Unit are managed by 
a committee consisting of two representatives from each interested 
Municipal Council and School Board. There is a Secretary, who, in the 
North Vancouver Unit, is also the Secretary of the District School Board. 
The Medical Director of the Health Unit attends all meetings and makes 
a monthly statistical and narrative report. 

Costs. — At the present time one-half the total annual budget is paid 
by the Provincial Department of Health and the Rockefeller Foundation, 
the remaining half being divided on a two-thirds and one-third basis 
between the City and the District of North Vancouver. 

The staff at present consists of a full-time Medical Health Officer and 
two Public Health Nurses, fully trained in modern public-health and pre- 
ventive medicine. We hope to have a secretary soon who will relieve the 
trained personnel of much office detail. Each member of the staff has 
a car. Two are personally owned and an allowance paid for their use. 
The third car is the property of the Health Unit. 

The office is on the ground floor of the North Vancouver General 
Hospital. This is a central location, close to the city schools, and about 
an equal distance from each district school. 

Our working-day is from 9 a.m. to 5 p.m., but as the unit is still in 
its infancy a great many hours' overtime are spent on reports and 
organization. 

The district includes the City of North Vancouver, having a popula- 
tion of approximately 16,000 with a school population of 1,800, and the 
District of North Vancouver, having a widely scattered population of 
0,000 or 8,000 with a school population of 720. There are five schools in 
the city, including the high school, and five in the district. The area 

49 



covered by the Health Unit extends from the boundary of West Vancou- 
ver on the west to Dollarton and Deep Cove on the east, from Burrard 
Inlet on the south, and as far north as there are people living up the 
mountain-side. 

The programme includes all phases of preventive medicine. The fol- 
lowing activities are specially emphasized : — 

(1.) Prenatal. 

(2.) Postnatal and infant-welfare, including a well-baby clinic. 

(3.) Preschool. 

(4.) School: (a) Annual physical examination by Medical Health 
Officer with parent present; (&) quick class-room inspection for conta- 
gion; (c) class-room inspection by nurse; (d) class-room health talks; 
(e) reporting of absentees; (f) readmission certificates ; (g) inspection 
of school premises; (h) home-school visits. 

(5.) Communicable disease: (a) Consultations; (&) quarantine and 
isolation procedure explained by nurse; (c) release procedure; (d) taking 
of swabs; (e) transportation of specimens to Vancouver General Labora- 
tory; (f) supply of antitoxins and vaccines; (g) tuberculosis visiting and 
organizing chest clinic for Provincial Tuberculosis Specialist. 

(6.) Investigation for remedial measures: (a) Neglected children; 
(6) crippled children; (e) blind and deaf, etc. 

( 7. ) Mental hygiene. 

(8.) Transportation of patients to medical doctors and clinics, etc. 

(9.) Special examinations made by Medical Health Officer for City 
Hall. 

(10.) Control to ensure safe milk, water, and food-supplies; inspec- 
tion of: (a) Dairies and dairy-farms; (6) restaurants; (c) meat mar- 
kets; id) grocery and confectionery stores; (e) bake-shops and all other 
food-handling establishments; e.g., barbecues, etc. 

(11.) Sanitation: (a) Public rest-rooms and lavatories; (b) sewage- 
disposal; (c) garbage-disposal. 

(12.) Supplying public-health literature, or public-health speakers for 
any meeting. 

(13.) Public-health exhibits at fairs, etc. 

(14.) Social service. 

(15.) Close co-operation with all organizations interested in public 
health. 

Our prenatal work is in its earliest infancy, but we hope before long- 
to be doing more. The postnatal and infant-welfare are covered by send- 
ing letters to the mothers of new-born babies, one for each of the first 
twelve months. We make infant-welfare visits as well and hold a well- 
baby clinic once a week. The Medical Director of the Health Unit attends 
these clinics. 

Our school programme is heavy. We are concentrating more on this 
work this year than we shall in the future. It gives us our introduction 
into the homes and so helps us to carry on the other phases of preventive 
medicine. 

Each child is to have a complete physical examination yearly. We 
are trying out the group method. That is, all of one family is done at 

50 



one time. We invite the mothers to be present, stating the hour at which 
her children will be examined, thus saving the interminable waiting - and 
waste of time so often found in clinics, school or otherwise. So far we 
have had 75 to 80 per cent, of the invited mothers present. It is a slow 
process, but we feel that seeds of prevention are being sown in fertile 
ground — the mothers' mind--and so a greater good is being done than if 
we proceeded by class-rooms, which is the more usual method. Next year 
we will perhaps revert to the system used in many schools, that of having 
the mothers present at the examination of the beginners only. 

Absentees of two days are telephoned or visited and are not admitted 
to school without a certificate from us. In this way we have kept com- 
municable diseases from spreading and have also increased the average 
daily attendance in the schools. 

All communicable diseases are reported by the medical men to the 
unit, which, in turn, reports them to the Provincial Department of 
Health. All diagnoses are confirmed by the Medical Director of the unit. 
The nurses quarantine, placard, and explain isolation and release pro- 
cedures under the direction of the Medical Health Officer. At first there 
Were many grumbles and rumbles, and sometimes real explosions, when 
patients learned there was to be no impressive policeman with his little 
sulphur candle, but honest-to-goodness house-cleaning with plenty of hot 
soapy water, elbow-grease, fresh air, and sunshine, when there is any. 

We have a map of the city and district in the office, on which we peg 
each case of communicable disease as it appears, using coloured map-pins 
for the different diseases. At the present time we have one peg on the 
ma j), diphtheria — there have been more. We have had two outbreaks of 
communicable diseases, one of diphtheria in the district; that was our 
initiation into our new job, and what a reception we got — something this 
new doctor and nurse brought with them to give themselves something to 
do. The other a chicken-pox outbreak in the city, about which you will 
read in an article by Miss Lowther published in the Bulletin. 

During the second week of February, Dr. Lamb, Provincial Chest 
Specialist, held a clinic under the auspices of the Health Unit. There 
were eighty-five patients examined. We feel that in establishing this 
clinic, with its follow-up visits, we have made a good start in our 
tuberculosis-work. 

The control of food, milk, and water-supplies is another big item. 
A survey of all food-handling establishments has been made by the 
Medical Health Officer and check-ups are made at intervals. All dairies 
supplying milk in this district have samples taken for bacteria count 
each week. The farms are inspected and advice has been given that has 
helped very materially in lowering the count, which is sometimes too high. 

We supply public-health literature and public-health speakers. One 
of our very first ventures was a public-health exhibit at the District Fair. 
We co-operate closely with all organizations interested in public health. 

We hope in time to have a model Health Unit which will prevent 
disease entirely and give people better health and longer life. 

Norah E. Armstrong, K.N. 
51 






PUBLIC HEALTH IX ARMSTRONG. 

Looking over the reports for the past year, 1 find we have made some 
progress. Although it is not very spectacular, it is well to know that 
we are going ahead, even if the going seems to be rather slow at times. 

One of the best of the individual pieces of work was done on a boy 
of 15 who had a harelip-cleft palate and chronic mastoid. Twelve years 
ago he had an operation on his lip, which was not a success. It was 
followed by a. mastoid which became chronic. Last summer the boy 
made two trips to Vancouver, first for treatment for the mastoid and 
next for the operation on the lip. Both operations were a success and 
the boy is back in school benefited both mentally and physically. We 
are very grateful to the local Canadian Legion, the Canteen Fund, and 
the Social Service Council of Vancouver for giving financial aid, and also 
to the surgeon, who gave free service. We hope at some future date to 
be able to have the palate remedied. 

For two or three years I have endeavoured to have a clinic to 
immunize the children against diphtheria, but very few seemed interested. 
A short time ago three cases broke out in the school. We immediately 
sent notices to the parents about a clinic and there was a splendid 
response; when we are finished (50 per cent, of the pupils will be immune. 

Every year we keep up with the vaccination for smallpox; fully 85 per 
cent, have been vaccinated. 

Dr. Lamb, with his chest clinic, has been a wonderful help to us, 
seventy-five pupils having had chest examinations up to date. The sus- 
pects and contacts are re-examined periodically. 

The senior grades have shown great interest in the first-aid competi- 
tions. Before Christmas ten boys procured their Junior first-aid certifi- 
cates to be eligible to enter for the St. John Provincial and Dominion 
championship trophies. 

The project for the " Little Mothers' " class last year was to make 
a baby book. It entailed a lot of extra work for the girls, but they 
seemed to enjoy doing it, and after it was completed I felt they knew 
more about the care of the babv than anv of my previous classes. 

With the help of Dr. Ootmar and his assistant, Mr. Watt, we had 
a very creditable health exhibit at the Interior Provincial Exhibition held 
here last September. We had a baby corner with posters, booklets, etc.,. 
but emphasis was put on the prevention of communicable diseases. This 
year we hope to obtain more space and enlarge the exhibit, picturing more 
phases of public-health work. 

The health corner in the school exhibit was truly worth while. Its 
success was due to the teachers and pupils, who spent much time and 
thought on the making of the posters and booklets. 

We still have a few children that are malnourished, who are encour- 
aged to bring milk to drink at 10 o'clock. In fact, most of the junior 
pupils bring milk daily. We have a number of children who do not bring 
adequate lunches; for these milk or hot soup is provided. We also have 
been presented with boxes of apples, which help out the meagre lunches. 

52 



Before closing this report I would like to mention the splendid 
co-operation that has been given by the Provincial Health Officer, the 
Armstrong School Board, and the staff of Hie Armstrong schools. 

Pearl Charlton, R.X. 



HEALTH-TEA CEDING IX SCHOOLS— A NEW IDEA. 

May I discuss the ever-present problem of teaching health in the 
public schools — schools being the most fertile places to try one's skill at 
putting over new ideas. 

Would it not be wise to handle this topic from the school-child's point 
of view? Does he appreciate my monthly inspections and the inevitable 
health talk that follows the inspection? Does he appreciate all the hours 
I have worried about getting up a talk for his special benefit? Does any 
of it sink in dee]) enough for him ever to think of it voluntarily after 
school-hours? Does he think anything about my advice to eat fresh 
vegetables as often as possible during the winter, and that a good all- 
round diet is the best fuel for growing boys rather than sweets, etc.? If 
I were in school with these up-to-date nurses telling me what is best for 
me, would I appreciate it? Do the parents pay any attention to wliat the 
bov may tell her about my health methods? 1 can almost hear vou say: 
"Well, if you are a (food nurse you will be bound to make an impression 
on some of the children, and if you do your teaching in an attractive 
way you are bound to put some of it over." I wonder! Hope springs 
eternal in the hearts of Public Health Nurses even as it does in the heart 
of youth, so we all go on, following out our prescribed rules for teaching 
health. It would be interesting to find out what percentage of the 
children derive benefit from it. 

This whole question has been a problem for me ever since I started 
school-nursing, and the result has been the birth of an idea which I have 
tried out on several occasions with a great deal of success, both in Van- 
couver and Cowichan. May I present it for' your perusal? 

Since it is the children we are working with in the hope that they, 
being the future adults, may get a measure of help from their nursing 
service, and be able to apply some of our teachings to their future every- 
day health, why not find out what they want to know? From this angle 
one can see that children, all the world over', are the most perverse ques- 
tion-askers it is possible to find, so let us give them a chance to ask their 
questions and try our best to answer them. 

My suggestion is this: Ask the principal's permission to lake over the 
next hygiene and health period, and devote the whole of that period to 
answering questions put by any one in the class. The teacher's permission 
is obtained too, of course, and the teacher will often ask the odd question 
himself, being perhaps as interested in the whole proceeding as the pupils 
themselves. I usually give the class a day's warning, so that they can 
gather their questions from hither and yon, home and abroad. 

53 



One is frequently amazed at the questions asked and the versatility 
of students. The upper grades are the only ones treated this way of 
course, and what a Grade VI., A T IL, or VIII. child doesn't want to know 
isn't worth knowing! 

Try it, and you will feel at the end of the session that you have " put 
over"" more health knowledge and satisfied more queries than you would 
ordinarily he able to do in years. 

Bertha Jenkins, R.N., 
Cowichan Health Centre, Duncan. 



PERSONALS. 



We are glad to welcome several new contributors to our Bulletin 
this year. Since the last issue the North Vancouver Health Unit has been 
opened, with Dr. G. F. Amyot as Health Officer and Miss Norah Arm- 
strong and Miss Elizabeth Lowther on the staff. Miss Dorothea Mac- 
Der'mot, formerly of Montreal, took charge of the School Nursing Service 
in Nanaimo, following Miss Armstrong's transfer. 

Miss Hilda Peters inaugurated a school-nursing programme in the 
Chilliwack City schools. Her place in Ladysmith was filled by Miss J, 
Worthington, of Australia. 

Miss Blanche Mitchell received an appointment as instructor in 
health education at the Normal School in Calgary. Her position as 
supervisor at the Cowichan Health Centre was taken by Miss Anne Yates. 
Miss Yates resigned at the beginning of this year in order to be married, 
and was succeeded by Miss Bertha Jenkins, formerly of the nursing staff 
of the Vancouver City schools. With Miss Jenkins's appointment as 
supervisor, her place on the staff was filled by Miss Ledwina Servos, a 
recent graduate in public health at the University of Washington. 

Saanich Health Centre saw several staff changes, as noted in her 
article by Miss Naden. 

New services were instituted in Penticton under Miss M. A. Twiddy, 
who was formerly at Oliver, B.C., and at Revelstoke under Miss Amy Lee, 
who was in charge of the District Nursing Service in Nanaimo several 
years ago. 

Miss A. M. Roberts, who went from Cowichan Health Centre to insti- 
tute a service in the Peace River' District, has written a very interesting 
account of pioneer work there. 

Miss Olive Ings was appointed to the Indian Service at Fort William. 
Her place at Westbank was filled by Miss Hilda Barton, of the Victorian 
Order of Nurses. 

Miss Flora McKechnie entered the matrimonial field the end of 
December. 

Miss Olive Garrood enjoyed an extended trip to Europe during 1930. 



VICTORIA, B.C. : 
Printed by Ciiaui.es F. 1!ankiki.i>, Printer to the King's Most Excellent Majesty. 

1031. 
450-331-4388 

54 




ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 1 



MARCH, 1932. 



No. 9 





I' -"'"*•" ''IH1 - WW r ' 5= 
■ ft x. »■■! . fii l« 




ARMSTRONG FIRST-AID TEAM, WINNERS OF THE LEONARD SHl^D, 1931. 



CONGRATULATIONS. 



IT HAS been said by an eminent authority, "A Public Health Nurse 
is much more than a graduate of a good hospital. She may be doing 
infant-welfare, school-nursing, tuberculosis or bedside nursing — an infi- 
nite variety of combinations — but she mnst understand how to enter the 
homes of the simple people, she must know how to teach and advise 
acceptably when she gets there, she must know how to get results in her 
community." 

So, because you are succeeding so well in fulfilling the strenuous 
demands a Public Health Nurse's job entails; because you are carrying 
forward the enviable record and reputation the Provincial Board of 
Health has in the eyes of its neighbours; because of your high courage, 
your zeal and enthusiasm, your splendid response to every situation — 

CONGRATULATIONS. 



X 
x 



TABLE OF CONTENTS. 

Page. 

Congratulations Front page. 

Editorial - 3 

North of the Peace River. By M. Claxton, R.N 3 

Carrying the Message of Health to Sayward, B.C. By Edith M. Walls, R.N. 5 
Our Responsibility for the Health of the School-children. By Elizabeth E. 

Martin, R.N 6 

Changes that are being made at Saanich Health Centre. By Esther S'. 

Naden, R.N 8 

School-nursing in Revelstoke. By Amy A. Lee, R.N 9 

The Public Health Nurse and Child-study Groups. By Margaret E. Kerr, 

R.N 10 

Summary of a Year's Work. By Hilda E. Barton. R.N ,.~ 12 

A" Vitamins for Health and Strength. By Annie F. Grindon, R.N 1* 13 

X " Health Must Come First." By Helen Kelly, R.N tL.&&kfe««* 16 

y Health-teaching. By M. A. Twiddy, R.N 17 

\ Getting the Pre-school Child Ready. By Eileen M. Carruthers, R.N 19 

v Health and Happiness for the Rural Families. By Isabella Craig, R.N. . . ... 20 

> Thoughts on taking over a District. By Emily G. Allen, R.N..kJ***^-*?^ 21 

" Finding your Footing." By Margaret F. Sutherland, R.N 22 

V Advancement along Preventive Lines. By Mary E. Grierson, R.N 23 

New Developments in Health-teaching and Clinics in Nanaimo. By Muriel 

Upshall, R.N 2-1 

Keeping a New Year's Resolution. By B. Thompson, R.N 25 

;\ The Possibilities in a Well-coordinated Plan of Development. By Geraldine 

Homfray, R.N 27 

How Impetigo can Travel ! By Heather Kilpatrick, R.N 29 

+ Measles. By Elizabeth Lowther, R.N 30 

Hurrah for a Bowl of Soup ! By Edith W. Tisdall, R.N 31 

V Public Health in Kamloops, B.C. By Olive M. Garrood, R.N 32 

Public Health Service South of the Peace River, B.C. By Nancy E. Dunn, 

R.N 34 

V The Chest Clinic in a Rural Community. By Bertha Jenkins, R.N 36 

v Health-work in Armstrong. By P. Charlton, R.N 36 

^ Views upon Education. By Winifred E. Seymour, R.N 38 

^What I have learned about the Hindu people. By Velma Miller, R.N..4!'.::.: 39 

The Effects of the Depression on Public Health. By Myrtle E. Harvey, R.N. 41 

y. " First Impressions." By Olive Ings, R.N 42 

" Out of the Mouths of Babes . . . " By M. Fyvie Young, R.N 43 

The Public-health Attitude. By H. Hillas, R.N 45 

A Day spent in the Mennonite Settlement at Yarrow. By Marion T. Card- 
well, R.N 45 

The Old Sulphur Candle. By Norah Armstrong, R.N . 47 

Some Experiences in the University Health Service. By Celia A. Lucas, 

R.N 48 

French Creek and District. By Dorothy E. MacKenzie, R.N 52 

Health Insurance and Public Health. By Dorothy E. MacKenzie, R.N 52 

Personals 53 



EDITORIAL. 

It has been my privilege to be editor of the Public Health Nurses' 
Bulletin for three years now. Perhaps because an editor has to be on 
close watch for misspellings, faulty grammatical construction, and, occa- 
sionally, ambiguities, I have read each article with a great deal of care. 
My enthusiasm knows no bounds, for this issue contains some of the most 
interesting articles I have read in any periodical for a long time. It 
seems to me an indication of our growth that there is a branching-out 
of the subject-matter in many directions. A more or less stereotyped 
form of article that reports progress only in terms of the number of 
visits made or the number of clinics held is missing the real purpose and 
value of this Bulletin. The underlying motive in writing any article 
should be, is there anything worth while in what I have written? Will 
it help even one person to do a better job because of inspiration she has 
received from my article? If we do not lose sight of that objective, all 
our articles will be so worth while that we will be beseeching the Provin- 
cial Health Officer to publish the Bulletin more frequently than once 
a year. 

Many articles in this book make interesting reading. You will be 
interested to read about Mrs. Thomson getting stranded in the Similka- 
meen River; of how Miss Olaxton's trip of 60 miles up in the Peace 
River country took her three days; of Miss CardwelFs descent upon the 
Mennonite schools, etc. There are so many articles that you will be 
interested in that I cannot enumerate further incidents. But I would 
like to recommend to you especially those by Miss Miller and Mrs. 
Grindon. 

In view of the fact that smallpox cases of a virulent type have been 
present in Vancouver, we would recommend for careful perusal the 
articles written by Mrs. C. A. Lucas and Miss Armstrong. 

Our combined thanks to the Provincial Board of Health for the 
Bulletin. 

M. E. K. 



NORTH OF THE PEACE RIVER. 

Public-health work as undertaken north of the Peace is probably, 
I think, unique in British Columbia. There are several reasons for this. 
One being that it is not a whole-time job, but is carried on in conjunction 
with hospital-work in a little Red Cross Outpost. Another reason being 
that it is essentially a pioneer country, and the settlers are very poor 
in this world's goods and very widely scattered. Many of them have 
been driven out of the Prairie Provinces by a succession of poor crops, 
and arrive here with practically nothing, to start all over again in a 
more fertile land. Some of them come in covered wagons, having driven 
their stock before them for many hundreds of miles. 

Their homes in many cases consist for some time of tents and shacks, 
usually plastered up with mud to withstand the climate ; all their efforts 



being directed towards breaking land and raising feed for their stock as 
soon as possible, and procuring the bare necessities of life for themselves 
and families. 

Even among settlers who have been in for several years very little 
actual money changes hand, but business is largely carried on by the old 
method of exchange and barter. 

Life being such an uphill fight, and the settlers being so occupied in 
just " keeping the wolf from the door," it is not altogether surprising to 
find that, although they appreciate a District Nurse, and are glad to have 
a little place where their babies can be born, the majority of them do not 
see much sense in preventive medicine. 

However, one has to remember that " Rome was not built in a day," 
and it is no good getting discouraged. By helping them in every way 
possible their confidence is gained and the way made open for the 
" word in season." 

Because the distances are so great and the roads so often impassable 
for some reason or other, the obstetrical cases usually come down to the 
Outpost in plenty of time. 

That waiting-time can be made very profitable. Their minds are 
usually in a receptive mood, and away from their household cares the 
women have more time and opportunity to think than they have had for 
a long time. 

Child-welfare in all its phases is discussed and all the family prob- 
lems brought to light ; and it is not only the mothers who come in for 
health discussions, but often the fathers and husbands too. 

It so often happens that when the new father visits the patient, or 
conies to take her home, he has to rest and feed his horses, and so joins 
us at a meal. This is often an opportunity for a lively discussion on 
some health question, such as vaccination or immunization of the new 
offspring. We hope that some new aspects of these subjects are shown 
up, and, at least sometimes, help given towards breaking down old 
prejudices. 

As I remarked before, very little money appears available up here 
just now, and hospital fees, if paid at all, are often paid in kind — such 
as a pig or a quarter of beef for a new baby, and a, load of wood or a 
couple of fowls for a pneumonia case ! 

When things are quiet in the Outpost, outlying schools and babies 
are visited on horseback or foot. In the fall, when no patients were 
expected in the Outpost for at least a week, a visit was paid to Hudson 
Hope, which is, I suppose, the most westerly point of this district. 

Though only 60 miles away, it took us three days each way to make 
the trip. The trail is very difficult in places, though very beautiful, wind- 
ing sometimes along by the Peace, and sometimes going many miles 
inland to skirt deep ravines and canyons. 

A woman missionary accompanied me, and we visited nearly every 
one along the trail. Some of the homesteaders are 7 or 10 miles from 
another habitation. The women live lonely if busy lives, and seemed 
very pleased to see us ; gladly putting us up for the night. Some of them 

4 



had not seen another woman to speak to for months, as very few go that 
wav. 

We visited the tiny school at the Halfway, and rounded up school- 
children, pre-schoolers, and all the inhabitants of the small settlement — 
my friend, the missionary, with a view to their spiritual needs, and I to 
their bodily. 

It was a new experience to both of us to ford the rushing Halfway 
River, but we were carefully shown the best place to enter and how to 
avoid the undercurrents, and so arrived at the other side safely, if some- 
what wet. 

Another tiny school to visit at the Hope, and a day spent in visiting 
prenatals, preschoolers, etc., and then we took the homeward trail again. 

The last night on the trail my horse broke loose and got away, 
leaving me stranded a good 20 miles from home. However, I didn't have 
to walk, as some one lent me another horse, and Paddy, the runaway, 
turned up at home a few days later. 

Though nothing spectacular in the way of public-health work was 
done on the trip, I felt at least that a few useful contacts were made, 
a few words of warning spoken, a few of encouragement, a little help 
given in regard to a difficult infant-feeding case, a couple of prenatals 
found, and two children with defective vision discovered in the schools. 
And, incidentally, my own mind refreshed and my eyes opened still more 
to the needs of the people. 

M. Claxtox, R.N. 



CARRYING THE MESSAGE OF HEALTH TO SAYWAR1), B.C. 

It is with much pleasure that I submit a brief summary of work 
done during the year 1931. The school is visited twice a month, and 
oftener if necessary. Child-welfare visits are made every month where 
there are babies and children under school age. Nursing visits are given 
where necessary and I try to keep in touch with the doctor on the 
Columbia Coast Mission boat. They call in at Kelsey Bay every two 
weeks when possible. Sometimes they cannot keep to schedule owing 
to storms and urgent calls. Any patient wishing to see the doctor goes, 
if possible, to Kelsey Bay. The doctor visits them if they require it. 
The district is scattered, though small, and there are still some families 
of the old school that do not believe in tonsillectomy and preventive 
methods in stamping out epidemics when it is possible to do so, by 
getting the children immunized against some of the infectious diseases. 
One must, however, be satisfied with the minority that are progressive, 
and even that is worth while. During the year there have been one case 
of scarlet fever and two cases of German measles, and during the months 
of December and January it seemed that every one had influenza; but 
the school-children are all at school and the majority of the people are 
better. 

The Lower Say ward School was not opened last September, as there 
were not enough pupils, but an arrangement was made between the 



trustees of both schools and the Education Department to send the 
pupils from the lower end to the Upper Sayward School. A closed car 
was engaged for the term and so the five pupils are able to get to school. 
Next year I think there will be enough pupils to open the Lower School, 
as there are more children ready to start school. 

Dr. Youlden, from Victoria, was in Sayward last August to attend 
to the teeth of school and pre-school children. 

The annual fair was held last September. The school -children took 
an active part in the way of school-work, vegetable-growing, sewing, and 
cooking, taking several prizes. A health exhibit was put on, where liter- 
ature, health foods, and posters were exhibited; prizes being given for 
the latter. The posters were made by the school-children. There were 
also races, etc., for children. After the judging was over the literature 
was distributed amongst visitors and residents. 

At Christmas the school-children gave an excellent concert, consist- 
ing of singing, recitations, and dialogue, ending up with a health play 
by Santa Claus and the school-children. Santa Clans then distributed 
presents and candies to all the children off the Christmas tree. Great 
credit is due the teacher, Miss Stewart, for her untiring work and 
interest in the children, which made it a success. Credit also is due the 
children for their hearty co-operation in learning their parts so well. 

The question of cocoa for school lunches I have brought up, but the 
majority of children have thermos flasks and bring hot milk or cocoa in 
them for school. In that way they get the hot drink at noon. I am 
very interested in the work in general and hope the time will come when 
there will be complete co-operation between parents, teachers, and nurses 
in the way of prevention and health laws for children. 

I have received copies of several of the radio talks on infectious dis- 
eases and have read a paper each month at the Women's Institute meet- 
ing. The radio talks are very helpful and are put as plainly as possible, 
so that any one can understand them. I received them from the Greater 
Vancouver Health League. I have some papers yet to read at the meet- 
ings and I am sure they will be enjoyed by the members. 

Edith M. Walls, R.N. 



OUR RESPONSIBILITY FOR THE HEALTH OF THE 

SCHOOLCHILDREN. 

Another year has gone by, and, considering everything, I think that 
we have had an unusually good year. 

One of the things accomplished this year was the immunization of 
about 500 of our school-children. We had no local cases of diphtheria, 
but several Indian children living between Vernon and Kamloops were 
brought into our isolation hospital. This was a great help in putting 
the immunization across. 



There has been no vaccination clinic for some years, but vaccination 
has been done from time to time by local physicians, especially since the 
outbreak of smallpox in Vancouver and cities south of the line. We are 
trying to arrange a clinic to be held in the near future. 

For the past few years I have conducted Little Mothers' League 
classes among the Grade VIII. girls. We have now finished the course 
for this year and fifty of the girls have written essays and received marks 
for them. 

Home-nursing classes have now been started with the Grade IX. 
girls. In this course we take: (a) Bedside-nursing; (6) feeding the 
sick; (c) how to give treatments and medicines; (d) communicable dis- 
eases; (e) emergencies and slight ailments; (/) health in the home; 
(g) infant-care; (h) the feeding of infants and children. 

These classes will continue until the end of June. I have carried 
them on each year and think that they are a great help not only to the 
girls themselves, but to those at home and others with whom they come 
in contact. There are thirty-three attending the classes this year. 
I have also done some of this work with the Girl Guides and have gone 
to camp with them as camp nurse for the past two years. 

During the cold weather all school lunches are eaten in one of the 
class-rooms under supervision. A great number of these children carry 
thermos bottles; others bring part of their lunch, soup, etc., in a glass 
container with a screw-top. These are heated on an electric plate in one 
school and on a jacketed stove in another. The majority of our children 
are exceptionally sturdy and the percentage of underweights fairly low. 
Provision is also made to give milk and cod-liver oil during the winter 
months for undernourished children. 

Last winter the I.O.D.E. organized and operated a soup-kitchen. 
A relief-room was also established to provide clothing, shoes, etc. This 
winter a committee was formed, representing all the societies of the city. 
Funds have been raised by voluntary contribution, the school staffs giving 
5 per cent, of their salaries as their contribution. A community chest 
was formed to provide work, food, and clothing for those who are in 
immediate need of help. In this way shoes and clothing have been pro- 
vided for our needy school-children. A wonderful work is being done, 
the people of the valley displaying, as always, a fine spirit of generosity 
and kind-heartedness to those in need. 

Dr. Lamb visited this district twice and held clinics. A number of 
adults and twenty-two children attended. No trouble of a serious nature 
was found among these children, although some are watched carefully 
and examined periodically. 

There is a decided improvement in the condition of the teeth of our 
school-children. It is good, and we are trying to make it still better by 
stimulating the interest of the children and parents and taking care of 
indigent cases through our school dental fund. 

Through the kindness of Dr. Ootmar a health exhibit was held in the 
home-economics rooms last fall. The parents were invited to attend, and 

7 



the exhibit was also used to give practical lessons in food values by the 
home-economics teacher. 

A baby and pre-school age clinic was held during the year and was 
well attended. 

As I go from grade to grade, giving our children health talks, I 
realize more and more the wonderful opportunity and great responsibility 
that is ours. I feel sure that the earnest health-teachers, no matter 
where they are, are developing a health consciousness among our children, 
instilling into their minds character-building material that is going to 
be a tremendous help in the years to come. 

Elizabeth E. Martin, R.N. 






CHANGES THAT ARE BEING MADE AT SAANICH 

HEALTH CENTRE. 

Again we have had several changes at the Saanich Health Centre. 
Miss Clare Rose resigned last June to be married. Miss Audrey Paine 
was transferred to Ladvsmith in July. Miss Margaret Sutherland and 
Miss Heggie Hillas, Sc.31, U.B.C., arrived in August to take over their 
duties. 

Due to the general financial depression our committee has been 
pondering over ways and means to curtail expenses. To our great satis- 
faction our staff has been left intact. We trembled for the fate of the 
school dentist, but his excellent work and the satisfactory results proved 
that it would be false economy to dispense with his services. Needless 
to say, the fees collected are considerably less than usual and more 
children are in need of free work. 

The Health Centre building has a number of rooms which have been 
unused. The upkeep has been very considerable. A janitor service has 
been necessary and fuel, light, water, laundry, etc., have been large items 
each month. The committee has decided to rent the building to Mrs. 
Thomson, a graduate nurse, who intends to start a private hospital. The 
nurses and doctor are keeping their offices as at present. The nurses 
are, for the time being at least, keeping their living-quarters, but we 
are making our own arrangements with Mrs. Thomson and the Health 
Centre Committee will have no further responsibility in this regard. 
The proposed arrangement will save the municipality between $1,500 
and $2,000 a year and there will be no curtailment in the services. 

We were very pleased to have our old Ford replaced with a 1929 
Chevrolet Sedan, which has travelled only a few thousand miles and has 
been Avell cared for. 

We were sorry to lose some of the members of our committee, but 
their places have been well filled, and we feel that our work and our 
welfare have received every consideration from the committee and the 
municipal authorities as a whole. 

To the Provincial Board of Health we owe our sincere gratitude 
for their unfailing help and encouragement throughout the past year. 

Esther S. Naden, R.N. 
8 



SCHOOL-NURSING IN REVELSTOKE. 



I can hardly believe that a year has passed since our Refresher 
Course, and that it is time for another Bulletin to be printed. I think 
we each look forward to seeing what the other is doing, and as we are 
not having our Refresher Course this year, the Bulletin will be even 
more interesting than other years, if that is possible. 

On looking over my reports for the last eighteen months, I am fairly 
well pleased with the results. It has been a hard year financially, and 
one hardly likes to ask parents to have their children's defects attended 
to. But then, again, how important it is for the child to be rid of any 
handicap! I am encouraged by the way parents have come to me and 
have asked me about their children, and with the number who have had 
their defects attended to. 

Last April our two local dentists gave their services free; they 
came into the schools and examined every child's month thoroughly. 
A chart was then sent home witli each pupil, and the parent was able to 
see just what was the condition of the teeth. This, I think, has been a 
great help with the dental work. 

In June, 1931, 1 found a number of children many of whom, though 
not underweight, had failed to gain in weight during the school-year. 
I visited most of the homes and drew the parents' attention to this, 
also to any defect the child might have. I got a splendid response. 
In one class there were eighteen out of forty who had not gained in 
weight. This year they have all made their gain. A number have had 
teeth attended to; others, some other defect, or the mother has been 
more particular about the child's diet. In some cases where I did not 
get the co-operation of the parents I would ask our school doctor to 
speak to them. This failing, I found the School Inspector could do 
wonders in helping me to persuade the parent some treatment was 
necessary for the child's welfare. There was, for instance, one boy 
whose eyes were defective. ITe was also losing weight and having to 
be sent home with a sick headache nearly every day. I paid several 
fruitless visits to the home; I asked the school doctor to speak to the 
parents, which he did, but with no result. Then I spoke to the Inspector 
about it and he said he would see the father. The father promised to 
have the boy's eyes tested some time, but the Inspector said, " Not some 
time, but now. May I take the boy for you?" The boy's eyes were 
tested and glasses given. He gained !) lb. from October to January and 
never had to be sent home with a sick headache. 

This winter I received a lot of splendid information about most of 
the poorer people of Revelstoke by working on the Investigating Com- 
mittee for the Christmas Cheer. It gave me an insight into who the 
most deserving cases were. I hope in the future some of the organiza- 
tions here will take up child-welfare work, so we may be able to have 1 
some of the children, whose parents cannot afford to have their defects 
attended to, looked after. Dr. Young's splendid address to the Rotary 
Club and the Canadian Club last fall has certainly made the people 
much more interested in school-nursing. One result of his talk was 

9 



that the Local Chapters of the I.O.D.E. and the Women's Auxiliary 
to the Canadian Legion have offered to put milk in the schools for the 
underweight children, or children who are not gaining in weight. 

Last year skin-diseases presented a great many difficulties. This 
year I have excluded three pupils for scabies. One had just come from 
Vancouver. All other skin conditions, which have been very few, I 
have been able to treat in the schools. I think I have all the children 
trained to believe it is a very great disgrace to have a skin condition 
and not report to me or their teacher, and that it will be serious for 
them if I find it when doing my class-room inspections. 

We have 760 children attending school. Two hundred and forty of 
these have received dental treatment since my coming here in September, 
1930 ; twenty-nine have had their eyes tested and have been given glasses ; 
ten more have had their glasses changed and eyes retested; eight have 
had treatment for ear conditions ; sixteen have had their tonsils removed ; 
seven have had treatment for goitre. 

Amy A. Lee, R.N. 



THE PUBLIC HEALTH NURSE AND CHILD STUDY GROUrS. 

When the first District Nurse commenced her work among the poor 
people of Liverpool some seventy-five years ago, she was looked upon 
with many misgivings by the better educated, more wealthy members 
of the community. Later, when her work was expanded to include 
school-nursing, the Boards of Education and their supporters were 
unanimous in their challenge — that this new departure was beyond the 
province of the nurse. The upheaval in the social structure as a result 
of the Great War and the realization of the tremendous handicap placed 
upon children by parental neglect led to the development of extensive 
programmes in the care of the infant and the pre-school child. This 
increased demand required a far higher standard of knowledge and 
training than heretofore for the Public Health Nurse, and resulted in 
a wider range of university courses adapted to meet the needs of the 
situation. 

Within recent years a new task has been laid upon this group of 
nurses, who are now shouldering many new responsibilities. The aver- 
age parents re becoming more concerned all the time with the psycho- 
logical development of the child. They have realized that there is a 
great gulf lying between their children and themselves in mutual assis- 
tance, companionship, and understanding. They are reaching out for 
more help, and the Public Health Nurse, in response to this " felt need," 
is striving to adjust her teaching to include this new development. 

Foremost among the organized groups who are thus contemplating 
this psychological phenomenon, the child, is the Parent-Teacher Associa- 
tion. Child-study groups have been developed in many organizations 
where problems relating to behaviour, moral training, etc., are discussed. 
It is with this group that there appears a real opportunity for the Public 

10 



Health Nurse with a broad understanding of children and a background 
of psychology. 

There are many communities where these study groups have not 
yet been formed. In the rural communities where there are no Parent- 
Teacher Associations, the Women's Institutes are very often eager for 
just this type of development. The Public Health Nurse frequently 
has to take the initiative in the formation of these groups, and as an 
aid to her I am appending a suggested outline of topics and the titles 
of a few books which are valuable aids in almost any branch of child- 
study the group may undertake. 

Every now and then you hear of a nurse, engaged in rural work, 
who remarks that after she has been out all day in the district, home 
looks the best place in the world to her in the evening. That nurse has 
a peculiar opportunity that is denied her city sister. The recreational 
and educational facilities of the rural district are limited. Even in 
this modern day, when the radio contributes lectures on worth-while 
topics and it is possible to procure educational motion-picture films, there 
is a distinct gap between the provision made for an enriched educational 
service in city and rural communities. This opportunity is afforded the 
rural nurse through the medium of the study group. 

Among parents, one will occasionally be found who frowns upon a 
young nurse giving advice on child training and care. The nurse has 
ample justification, as she can readily demonstrate to the parent. 

The study of child-psychology teaches us that there are definite 
differences in all children. Many of them suffer from mental or physical 
handicaps which tend toward the development of an inferiority complex. 
Parents must realize that it is not the actual handicap that counts, but 
the child's attitude toward it. They must strive to give the child the 
best background possible, not pushing him beyond the limit possible 
for his inherited ability, but allowing him scope to develop all his potenti- 
alities. 

Topics may be chosen from the following for discussion at the meet- 
ings of the study groups. There are many other topics that will suggest 
themselves to the leader of the group as the discussions progress. 

(1.) Heredity and the individual differences in inheritance. 

(2.) Environment as a controlling factor on heredity. 

(3.) Development from birth to maturity. 

(4.) How habits are formed. 

(5.) Developing attitudes. 

(C>.) Fears, and other emotions. 

(7.) Moral training. A child's ideas of punishment. 

(8.) Temper tantrums and other behaviour difficulties. 

(9.) Play interests of children. 

(10.) Children's interests in collecting. 

(11.) Children's books. 

(12.) A child's ideas of religion, etc. 

There are many very valuable books that may be procured. Many 
can be borrowed from the Open Shelf of the Provincial Library. Many 

11 



others are available at other libraries. The average nurse cannot afford 
to buy a large library, but certain books are invaluable in child-study. 
I am including the name of the publisher and the approximate price of 
the various books: — 

(1.) Blatz, Win. E., and Bott, Helen McH. : Parents and the Pre- 
school Child (Dent & Sons, Toronto, 1929). Price, $1.50, 

(2.) de Schweinitz, K. : Growing Up (Macmillan Co., Toronto, 1928). 
Price, $1.75. 

(3.) Thorn, Douglas M. : Every-day Problems of the Every-day Child 
(1). Appleton & Sons, New York, 1927). Price, $2.50. 

(4.) Blanton, Smiley: Child Guidance (Century & Co., New York, 
1927). Price, $2.25. 

(5.) Terman, L. M., and De Lima: Children's Books and Reading — 
A Guide for Parents (D. Appleton & Sons, New York, 1926). Price, $2.25. 

(6.) Bolton, F. : Adolescent Education (Macmillan Co., Toronto). 
Price, $2.50. 

(7.) Tisdall, Fred F. : The Home Care of the Infant and Child (J. M. 
Dent & Sons, Toronto). 

(8.) Brooks, F. B. : Psychology of Adolescence (Houghton & Mifflin, 
San Francisco). Price, $3. 

(9.) Jones, A. (}.: Vocational Guidance (McGraw-Hill, New York). 

(10.) Richardson, Frank: The Nervous Child and his Parents 
(Putnam's Sons). Price, $2.50. 

(11.) VonGruber: Hygiene of Sex (Williams &Wilkins, Baltimore). 

(12.) Newman, H. : Education for Normal Growth (D. Appleton & 
Sons, New York). 

(13.) Heaton, K. L. : Character Building through Recreation (Uni- 
versity of Chicago Press). Price, $1.85. 

(11.) Blatz and Bott: The Management of Young Children (McLel- 
land & Stewart). 

(15.) Van Water, M. : Youth in Conflict (New Republic, New York). 
Price, $1. 

Margaret E. Kerr, R.N. 



SUMMARY OF A YEAR'S WORK. 

The second year of the Westbank-Peachland District is past and the 
generalized programme that we are carrying out here has proved very 
interesting. 

Visits. — Five hundred and twenty -three nursing visits were made; 
237 educational visits, including prenatal, postnatal, and infant-welfare; 
and seven confinements attended. 

Clinics. — Under the supervision of Dr. Ootmar, M.H.O., five well- 
baby and pre-school clinics were held in Westbank, with a total atten- 
dance of sixty. We all appreciate Dr. Ootmar's keen interest in this 
branch of our work. 

12 



Chest clinics were held in Kelowna Hospital in March and Septem- 
ber. Fourteen T.B. suspects from Westbank-Peachland District were 
examined by Dr. Lamb, Travelling Diagnostician. 

In Peachland a class of thirteen girls completed a course of twelve 
lessons in mother-craft. The closing exercises took place in May, Avhen 
the girls received their certificates and pins. In October the class 
repeated this demonstration to the Peachland Women's Institute. 

School-work. — Regular school inspections have been made. Health 
talks were given and the children encouraged to establish good health 
habits. One hundred and seventy-three home visits were made in the 
interests of the children. 

In March, 1931, Grades I. to V. in Westbank Townsite School gave 
a concert to raise funds for a much-needed lunch-cupboard. A play 
entitled "Milk the World Over" was a leading number. The sum of 
|18.50 was realized. The splendid co-operation of the teacher, Miss 
Mossey, and the mothers who made candy to be sold the night of the 
concert, and the enthusiasm of the pupils themselves aided in making 
this concert a success. 

Indian Reserve. — It is pleasing to note the friendly attitude these 
Indians have toward the nurse compared to what it was a year ago. 
Nursing care is given when necessary, and then I have an opportunity 
to give the whole family a health lesson, stressing the importance of 
reporting any illness to the nurse. 

We are indeed grateful to the Westbank Women's Institute for the 
furnishing of the nurse's office with a desk, cot, and curtains. 

Hilda E. Barton, R.N. 



"VITAMINS FOR HEALTH AND STRENGTH ! "—A HEALTH 

EXHIBIT AT KELOWNA, B.C. 

The best time for a health exhibit concerning the value of vitamins 
is undoubtedly in the fall of the year, when the thoughts of all are 
centred on the rich harvest of tield and garden produce, and there are 
many varied home-grown and home canned vegetables and fruits which 
may be used for demonstration purposes. 

With this thought in mind at the time of the Kelowna Fall Fair, 
Dr. G. A. Ootmar, District Medical Officer of Health, planned an 
exhibit of fruit and vegetables which would interest the general public 
in the vitamin values contained in their own home -grown produce. 

A large expanse of floor-space was needed for the exhibit, which was 
displayed in an emptied well-lighted school -room. 

Some 150 different varieties of fresh and canned vegetables, fruits, 
and foodstuffs were shown, each separately arranged on a labelled picnic 
cardboard plate, together with the appropriate number of differently 
coloured 1-inch wooden cubes, to represent the relative distribution of 
vitamins A, B, and C in that particular vegetable or fruit. 

13 








14 




It was most interesting and instructive to walk around the tables 
and note the different vitamin values of each food material displayed ; 
also the difference in vitamin content of dried and canned fruits and 
vegetables compared with the fresh article. 

Posters were hung on the surrounding blackboards, with blackboard 
drawings and descriptions of the effect of the lack of vitamins A, B, C, 
and D on children, guinea-pigs, dogs, and rats. 

A special edition in booklet form of the Okanagan Health Journal, 
prepared for the exhibit by Dr. Ootmar, was given to all attending. 
On the cover were the words " Many of us depend on newspapers for 
our education ; their advertisements praise loudly the worth of the 
vitamins contained in the foods they advertise. With the aid of this 
special edition of the Health Journal you will find the vitamins in the 
produce of your own garden, orchard, poultry-yard, and dairy, and in 
the store of your groceryman." 

In this booklet interesting facts were given about vitamins, written 
in simple language, so that even the children could understand the full 
meaning of the project. 

The exhibit was especially much appreciated by the high-school and 
home-economics pupils, who came in classes with their teacher, Miss 
Woodworth. 

It is interesting to note that the Grade VIII. class in Home Eco- 
nomics made the highest average marks in the Province out of 150 classes 
which took the recent Provincial examination in food values. 

Special thanks were tendered to Dr. Ootmar for the help which had 
been given through this valuable teaching display. 

In appreciative co-operation with Dr. Ootmar's novel idea, the Public 
Health Nurses in their turn prepared an amusing exhibit for the younger 
children of vegetable mannequins, entitled " The Vegetable Parade in 
Health Land." An imposing " House of Health " (19 by 24 by 26 inches) 
stood in a large garden of vegetables, grass, and nut-trees. With stuccoed 
walls of rolled oats, basement of dried peas, tiled roof of graham and 
soda crackers, chimneys of milk-bottles, window-curtains of lettuce-leaves, 
window-boxes of prunes and red peppers, door-posts and shutters of 
brown bread, and door-steps of cheese, it looked most attractive. A wide 
curved driveway of rice, bordered with prune and raisin curbstones, 
passed in front of the doorway. At the bottom of the garden was a wall 
of prunes and raisins, with Avide drive-gates of macaroni. 

Standing at the door was " Kind Nurse Milk," in blue dress and 
white cap and apron, holding by the hand little " Eva Egg," whom she 
had brought to see the " Vegetable Health Parade " marching by on the 
road at the foot of the garden. 

Heading the parade was " The Pure Gold Band," of seven carrots 
dressed in white trousers, blue capes, silver buttons, and small green- 
pepper hats, led by a large Major Domo carrying the Union Jack and 
a banner, "The Pure Gold Band. The Pride of Ilealthville. We put 
Health in your cheeks and pep in your step! " Mr. and Mrs. Bean from 
the country in their new " squash " car followed the band, " Queen 

15 



Lettuce " sitting in the back seat with a banner, " I serve you well all 
the year round." " The Squash Car," with its green body, and steering- 
gear and wheels of beet-root which " really turned round," delighted the 
boys, small and big, and " Queen Lettuce " looked particularly attractive 
in the back seat, with her bright black eyes (pins) and frilly green skirts! 

Next came "The Strong Family" — "Onions for Health and Strength." 
" Mr. and Mrs. Strong," with two children, dressed in green shorts 
and yellow skirts, doing their exercises with dumb-bells of peanuts ! 
These caused much amusement, but perhaps even more amusing were the 
corn-cob horses with corn-silk tails and green-pepper heads, which made 
them look like weird prehistoric animals. They were gallantly driven 
by the " Fat Tomato Lady," in her jaunty hat of green pepper, seated 
in a chariot of cantaloupe with wheels of beet-root, bearing the slogan, 
" Beets ! Ave keep the wheels of your system running smoothly." As the 
Kelowna Capital News expressed it, " . Two horses of corn-cobs 

with flowing corn-tassel tails, drawing the ' Fat Lady ' of the tomato 
family, expressed speed ; their stream-line bodies and green-pepper heads 
looked as if thev would iust ' eat up ' any distance. . . . All who 
saw the display were most fascinated, and, whether young or old, will 
long remember this unusual and interesting portrayal of health foods." 

By special request the exhibit of the Health Nurses was afterwards 
moved to the Kelowna Public School, where it was much enjoyed by the 
children for several days until the vegetables faded. 

An important feature of Dr. Ootmar's vitamin exhibit is that it 
can be loaned to any organization which can supply the perishable fruits 
and vegetables locally. It has already been loaned to. different Women's 
Institutes; and to the Home Economics Department in Vernon School 
for teaching purposes. Jt has also been set up as a health exhibit at 
Armstrong Fall Fair, and has proved a most valuable method of impress- 
ing vitamin values in foods on the mind of " the man in the street," who 
is naturally much interested in a project using his own home-grown 
products to demonstrate the presence of the valuable vitamins which 
are so essential to the proper development and well-being of the human 
body. 

Anne F. Gtrindon, R.N. 



"HEALTH MUST COME FIRST." 

As I have been only six weeks in this district, I am not in a position 
to give a detailed resume of the work here. Upon my arrival, when I 
first caught sight of the steep, snow-clad hills of Port Alberni, the thought 
occurred to me, Would I ever have nerve enough to climb those hills in 
a car, having been accustomed to driving on fairly flat-surfaced roads. 
It seemed to me that transportation Would be a real difficulty, and I 
soon found my fears had not been 'groundless. 

More than once when I had started out on these icy roads I felt like 
turning back, but just kept on going. It snowed almost continuously 

16 



for the first two weeks after I arrived here. The poem " Snow, Snow, 
beautiful Snow " did not appeal to me in the least and 1 ardently wished 
it would go, and lived in the thought, " Spring is on the way." 

I spent a large part of the first month finding my way around, 
locating the various schools and villages, and calling on the local people, 
who did much to make me feel at home and showed a keen interest in 
the work. 

1 found the health-education programme well started, particularly 
in the infant-welfare department. The very great number of young, 
interested mothers, who were anxious to follow the advice given to 
them, that their baby might have every chance in life, made me feel 
that health education is beginning to be practised by the laity, and 
impressed me very convincingly that more people from year to year 
are realizing that our aim is education in obtaining and maintaining 
health. 

It has pleased me greatly since coming here to note the emphasis 
that has been laid on child-welfare, and to find the mothers are now 
beginning to understand better the importance of proper care in the 
pre-school years of the child's life. 1 feel that much more intensive work 
at this period of the child-life must be accomplished by us. I found a 
well-established and well-attended baby clinic here. 

The dental inspection of the children attending school revealed the 
usual appalling number of dental defects, which has made it very evident 
that the solving of the dental problem is a very urgent matter here. 

I think a safe means by which to measure our progress in the public- 
Jhealth field is to note the awakening of more individuals in a community 
of the class who are desirous to help on the work, and this I am sure 
is the case here. It is evident, and pleasing to note, that the preserva- 
tion and care of health is becoming more widely practised by the people 
themselves, of whom a growing number have accepted the slogan, " Pre- 
vention is better than cure," and from these results we take fresh courage 
in our work. Day by day it becomes more evident that the trend of 
thought is, unmistakably, " health must come first." 

Helen Kelly, R.N. 



HE ALTH-TEAC Mil N( \ . 

Nurses who have taken the Public Health Course have often heard 
the phrase " Educate people " as a solution to health problems — teach 
the prevention of tuberculosis; teach children health habits; teach, 
teach, teach! Some of us feel at times that we are not born teachers, 
nor have Ave had the regular teachers' training; hence we grasp at any 
new method of presenting health lessons. 

Here is one on general health which I find has interested the children 
of Grades III., IV., and Y. The idea originated from Dr. Hill's com- 
parison of an individual to a car in the first chapter of " The New 
Hygiene." 

17 






Lesson Plax. 

Title of Lesson. — " The Car and the Body Machine." 
Teacher's Aim. — To encourage good health habits through the pupils' 
knowledge of a car. 

Pupils' Aim. — To learn how to drive the machine properly. 



Subject. 

Introduction 
to lesson. 

Link up 
pupils' 
previous 
knowledge 
of cars. 

The body 
machine. 

Food — oil, 
water, air. 



Lights. 



Other 
protectors. 



Battery — 
heart. 

Vital 

essentials. 

Wears out. 



Keep clean. 



Repairs — 

garage 

(hospital) 

mechanics 

(doctors). 



Other ways 
we are like 
a car. 

Good drivers 



Heeds 
warnings. 



Method of Presentation. 

Name one thing a car needs to keep it running? Gas- 
Yes. Another thing? — Oil. Another? — Water. Anything 
else? — Air. Yes, we need all these things for the car. 

Do you know there is another machine that needs all these 
things to make it run properly ? — Our body machine. We need 
fuel — food of the proper kind — or we will soon wear out, as 
the car does if poor gas is used. We have oil in our joints — 
we need to have air and water circulating to live and wear well. 

Lights of a car are used for protection — our eyes tell us 
when danger is about. Learn to steer straight and keep your 
car out of the ditch (prevent accidents). 

Can you name any other protectors a car has? Brakes — 
Yes. We sometimes have to use our muscles to stop quickly 
if in danger — and take a rest if tired. Guards — cover of 
engine, etc., like our skin. Bumpers and shock absorbers, etc. 

Battery may be compared to the heart. It runs the starter 
and sends out electricity to all parts, etc. 

The parts of a car wear out — the car lasts longer if care 
is taken of it. Our body machine also wears out quickly if 
we do not give it the proper care. 

Car must be kept clean inside and out. If not kept clean 
it will not wear well, etc. 

Both have to be mended if accidents happen. The differ- 
ence between us and a car, we cannot buy new parts and be 
as good as ever. So we must care for the parts we have. We 
can get new teeth, but they are never the same as our own, 
and we cannot see with a glass eye. 

Can any one think of another wav we are like a car? 
Answer: We get stiff and it is hard to run when we get old. 

Good drivers know their machine, know warning-signs 
that the machine is not running properly, and will stop the 
car and let it rest. Will find out if oil, etc., is needed. 

So we have warnings (as headaches) that our body ma- 
chine is not running properly. We must always stop to see 
what is going wrong. It is always best to care for the machine 
daily, so no warning will come. Good drivers know all about 
the machine, so we must learn all Ave can about our body 
machine, so we can steer it properly, keeping out of the ditch 
(hospital). Learn to be careful drivers and you will get the 
longest and best life from the machine. Do not be satisfied 
with just keeping out of the ditch, but choose the best and 

18 



most comfortable road for the machine. Avoid the rough 
roads of sickness and ill-health by forming good habits that 
will help you to maintain health. 

A man too busy to care for his health is like a mechanic 
too busy to care for his tools. — Cicero. 

M. A. Twiddy, R.N., 

. Penticton. 



GETTING THE PRESCHOOL CHILD READY. 

" Dear Mrs. : 

"All children who are commencing school this February are invited 
with their mothers to a preschool clinic, to be held at the Legion Hall, 
Friday, January 22nd, 1932." 

Each child throughout the elementary school who had a small brother 
or sister or friend, ready to commence school, at the beginning of the new 
term, eagerly conveyed the messages to the mothers of prospective pupils. 
Twenty-eight such invitations were delivered; a notice to the same effect 
was inserted in the local papers, and a similar announcement made to the 
high-school students. The response was gratifying, for on the appointed 
day eighteen pre-school students, accompanied by " mother or big sister," 
arrived at the clinic. These eighteen children represented 50 per cent, 
of the total number of beginners who registered at the schools on Febru- 
ary 1st. On entering the clinic, each child was given an admission form 
on which was written his or her name and age. Each in turn was brought 
to the first nurse, where height, weight, and normal weight were deter- 
mined, and entered on the admission card. There, also, foot impressions 
were taken, not by means of a pedograph, but by painting the soles of the 
feet with a solution of ferric chloride. The impressions were recorded 
fairly successfully on drawing-paper. 

From the first station the child with its mother passed on to the 
second nurse, who made an examination of the teeth, tonsils, and general 
posture, discussing these and the health habits of the children with the 
mother, and advising medical or dental attention where necessary. 
Health literature was also distributed to the mothers. 

A committee from the Public Health Nursing Council served refresh- 
ments to the mothers and children. From 3.30 to 4 p.m. Dr. Drysdale, 
the Nanaimo Medical Health Officer, spoke to the mothers on " Health 
problems of the child from 2 to (5 years. 11 This address seemed to be 
greatly appreciated by the mothers. 

Although this clinic or pre-school round-up was held so short a time 
before school commenced, the results were evidenced in many ways, 
especially in regard to dental care. In my opinion it has created a 
clearer understanding between the mothers and the School Nurse, which 
in turn will establish a greater spirit of co-operation between the home 
and the school. 

19 



In the five Nanaimo schools there are 1,263 school-children; of these, 
about 250 attend the high schools (junior and senior). The regular 
health programme is carried on. Each month the classes are inspected 
for cleanliness and possible skin-diseases (of which there are many), and 
each month the underweights are weighed. Once a year, eyes, ears, 
teeth, and posture are carefully examined and defects recorded. Unfor- 
tunately, the children receive only one examination by the school doctor, 
and that is during the first two months of schooling. During subsequent 
years the physical examination of pupils is done by the nurse. 

The condition of the teeth of the school-children is still distressing, 
although an improvement Avas noted after Dr. Harry Thompson's visit 
and lectures last spring. However, a large percentage of the school- 
children, especially in the elementary schools, are badly in need of dental 
care. 

Little Mothers' League classes have been given to about sixty girls 
in the high school, these girls being taught the fundamentals of child-care. 

At present Nanaimo is in the midst of an epidemic of measles. On 
January 5th the first case was reported, and since then the cases have 
increased in waves. A closer supervision of the schools would greatly 
aid in the control of the epidemic, but supervision is difficult without a 
car. However, the school-teachers are giving splendid co-operation and 
we hope that the epidemic will soon spend itself. 

Eilebx M. Oarruthers, R.N., 

Nanaimo. 






HEALTH AND HAPPINESS FOR THE RURAL FAMILIES. 

My first impressions of the Okanagan were of a veritable fairy-land — 
snow-laden pine-trees ; soft feathery flakes of snow were floating earth- 
ward. A paradise to work in, I thought. 

At frequent intervals class inspections bring the best part of the 
Oliver Project scurrying down the aisles, with clean hands and shining 
faces. There are a goodly number of children with dental filling.-!, that 
were put there, probably, after much painstaking effort on the part of the 
Public Health Nurse. At the close of the period Ave talk about many 
interesting subjects — lunch-pails, what ought to be in them and where 
they ought to be kept during school-hours ; of the ship of health manned 
with a crew of healthy boys and girls. Out of forty Grades I. and II. 
children eight have less than normal vision; the upper grades are giving 
higher percentages. When! Oh, when! Defects, will you be corrected? 

The competition for the Eraser health cup is an annual event in the 
Oliver and District schools. This year, to provide a pleasant change, the 
teachers are being encouraged to work on a definite health project, each 
child making a contribution to the Avhole. We are hoping to have a very 
interesting exhibit When the contest closes. The teachers also have 
devised various novel methods of keeping health-chore records. 

Baby and pre-school clinics are the joys of the Oliver and Osoyoos 
Districts. One of the most spacious homes is used, providing an eco- 

20 



nomical and convenient meeting-place. The clinics are well attended, and 
their success is chiefly due to the enthusiasm of members of the commu- 
nity in charge. 

You arrive into the living-room of the ranch, with its cheery fireplace, 
around which, at this time of the year, are grouped the pre-school chil- 
dren, enjoying an unusual luxury, and watching fairy palaces in the glow- 
ing logs. Here the babies are undressed and weighed and every one 
becomes acquainted. The kitchen makes a very comfortable examining- 
room, where the doctor and nurse are alone with the mother and her 
baby. 

The Okanagan Falls District was unfortunate in having an epidemic 
of scarlet fever during the fall months, and they are looking forward to 
their annual open clinic with greater zeal than ever before. It is a sad 
story, but already several marked defects following complications are 
noticeable, one child being still out of school. We are expecting a heavier 
toll in the final examination. 

Vaccination and immunization are topics frequently under discus- 
sion throughout the districts at the present time. We are awaiting the 
result, perhaps, of many conferences, but the organization and ammuni- 
tion are ready. 

The work on the Inkaneep Reserve is a pleasant change when the 
paleface tends to become monotonous. To accomplish most among the 
Indians, as among other peoples, whose habits are so different from ours, 
it would seem essential to study their background, historical data, folk- 
lore, and to gain a speaking knowledge of the tribal language, in order 
to gain the confidence of the older people. This knowledge is difficult to 
acquire, but the work of past nurses has made an entrance into the homes 
a simple matter, and from that vantage-point I am trying to stumble on. 

Dr. C. E. A. Winslow, in his new book, " Health on the Farm and 
in the Village," a review and evaluation of the Cattaraugus County 
Health Demonstration, says: " Surely, the farm dweller has his right to 
the guarantee of 'life, liberty, and the pursuit of happiness'; and of 
this guarantee, health forms an essential and necessary part ! " Surely, 
it is a privilege to be a part of the great machinery striving to gain for 
the rural dweller this most necessary part of the guarantee. 

Isabella Craig, R.N., 

Oliver. 



THOUGHTS ON TAKING OVER A DISTRICT. 

Having taken charge of this district less than two weeks ago, I am 
not in a position to write, from experience, of the work and progress 
made during the past year. I have, however, looked over the records and 
notice that a pre-school clinic has been added to the list of child-welfare 
work. I feel that this branch of service should be well encouraged, for 
the physical well-being of the child from babyhood to school age is all- 
important, and hitherto these little people have been "left out in the 
cold," so to speak, except for the occasional link-up with home-visiting. 

21 



The general health and care of the children here has received good 
report on the whole, but during the past two months measles has found 
its way in, and consequently school attendance, clinics, and Little 
Mothers' League classes have been interrupted. We hope, however, to be 
in a position to resume a normal routine in March and to advance in our 
work in its many branches. 

One still finds a mother keeping all the children home from school 
because " Johnny " has the measles or chicken-pox. It is interesting to 
be able to explain to the parent that this is no longer necessary and to 
outline the present methods adopted for the control of infectious diseases. 

A tuberculosis clinic is held twice a year, when Dr. A. S. Lamb, 
diagnostician of that disease, visits and examines contacts and suspects 
referred to him by the health authorities here. About ten patients were 
present at the last clinic. 

Of the outlying districts, eight in number, I have yet only visited 
five, and only by way of an introduction through the courtesy of the 
Medical Health Officer. 

It is hard to realize that I have been here so short a time, as the 
co-operation I have received from the members of the Board and the 
teaching staff make me feel that I have known them for a considerable 
period. I can also speak in like manner of my home visits; this surely 
proves that a good foundation has been laid here in previous years by 
others holding my position. 

Emily G. Allen, R.N., 

Ladysmith. 



U T71 



FIXDIXG YOUR FOOTING.'' 

In reading the life of Sir William Osier not long ago, I found that as 
a boy he had received the same advice that was given to us in lectures 
last year — written in Carlyle's words : " Our main business in life is not 
to see what lies dimly before us, but to do what lies clearly at hand." 
In the past eight months at Saanich I have so often thought of this 
counsel, as, coming fresh from five years of the theoretical side of public 
health, one early learns that by being steady and persistent far more is 
accomplished than by being over-enthusiastic. 

Situated as Saanich is, a large country district containing up to the 
past month no hospital, resident doctors, or bedside-nursing order, a 
generalized programme has been necessarily carried on. Previously the 
four nurses have been each taking a special branch of this, as child- 
welfare, bedside-nursing, and school-nursing. But this year we have 
divided Saanich into districts, each nurse being responsible for carrying 
out a full public-health programme therein. We each have definite days 
for working in the schools, the remainder of the week being devoted to 
welfare and bedside-nursing. In the mornings, while planning the visits 
for the day, we discuss each case, and in that way keep in touch with one 
another's families. Then, too, Ave compare the constructive work and its 
success in the various districts. 

99. 



So far this new division has proved satisfactory, especially as Miss 
Hillas and I are both new to the practice of public health. It has given us 
a much clearer picture of the programme in its entirety, and has enabled 
us to become acquainted with the family as a unit. Now that we are 
familiar with our district, we are finding that so much more can be 
accomplished when the family knows you. Again, with the social-service 
work unavoidably increasing, we have found it of inestimable value when 
making an investigation to be familiar with the agencies. 

I would like to say how much more the two words " public health " 
mean to me, and increasingly so with each month of practice. Also of 
what value it has been to be with two such experienced Public Health 
Nurses, as there are so many new situations and view-points to be met. 

Margaret Sutherland, R.N., 

Saanich Health Centre. 



ADVxVNCEMENT ALONG PREVENTIVE LINES. 

The impulse to omit sending in an article for the Bulletin held 
almost too long — or not long enough. Having been in each of the two 
districts but about four weeks, and having found a live epidemic of 
measles in each one, kept one busy and made one feel that trying to stem 
the tide of the disease was all that had been even attempted. 

But I can write of the splendid work accomplished by my predecessor, 
the organizer of the health-teaching here; the size of the fields and the 
usual obstacles which must have been but an incentive to good work for 
her. There is an unusual health consciousness in manv of the different 
staffs of schools and societies, and a willingness to help also. 

In spite of the ever-present depression there are advances in the pre- 
ventive care for the districts. Anti-goitre tablets for Mission District will 
be given to the pupils of the public schools in prophylactic doses, begin- 
ning the first of March, the organizing for which service had been done 
before Christinas. Vaccination clinics are now being held in all the 
schools in Mission District, the work being clone free to the people; the 
Medical Health Officers merely receiving their retaining fees. Some 300 
pupils have never been vaccinated in the schools of 720 attendance, but 
we hope that the number will shrink to a small figure, as a great many 
have stated their wish to be done — teachers and others as well as pupils. 
The cases in Vancouver have influenced those who have objected hereto- 
fore. 

Dr. Lamb held a very satisfactory chest clinic on January 22nd and 
23rd; thirty-five being examined, all but three of whom were found to be 
free of tubercular disease. The attendance of patients asking to be 
examined is an encouraging part in the fight against the dread disease. 

Giving first aid and home-nursing to a large C.G.I.T. group in the 
Maple Ridge District is an interesting and instructive proceeding. Some 
of the mothers are attending and entering into the classes at times. 
I find the students very keen indeed. 

23 



But, Oh ! for the time and staff for the prenatal infant, welfare and 
preschool work, a much-needed part of any programme, but which here 
at present can merely be touched on at intervals, as one is only in each 
district alternate months and the schools and home-school visits take up 
the time. Of course much of the subsequent school-nursing could be elimi- 
nated if the two earlier stages could be thoroughly attended to, as has 
frequently been demonstrated. It is difficult just now to make all realize 
that individual advice is so necessary with infants, no two being the same 
in habits and reactions, and that the pre-school defects are so frequent 
and so seldom corrected in that stage. The letters from the Department 
are very helpful indeed, but many parents need them supplemented by 
personal advice for individual problems. 

There is a splendid opportunity in this large field for good work, as 
the School Boards, school staffs, women's societies, and others are so 
willingly co-operative. The harvest should be large. 

Mary E. Grierson, R.N., 

Mission. 



NEW DEVELOPMENTS IX HEALTH-TEACHING AND CLINICS 

IN NANAIMO. 

During the past year more time has been spent on that ever-interest- 
ing and satisfying phase of public-health work, clinics and teaching. 

Probably one of the most advantageous undertakings of the year was 
a well-baby clinic held in the local hospital under the auspices of the 
Women's Auxiliary, who were celebrating the jubilee anniversary of the 
Nanaimo General Hospital. Seventy babies were registered and forty- 
six were weighed during the afternoon. Health posters of all kinds were 
exhibited. This also gave an opportunity for an exhibit which dealt with 
the child's diet up to 1 year of age. Samples of prenatal diet and the 
baby's diet from birth to a year were shown. For the 1-year-old a day's 
menu was given, showing three sample meals. 

On another table were the necessary articles for habit-training, with 
a suggested routine schedule for a child's day. A complete layette was 
also displayed and valuable literature distributed. 

Another ambition was partly realized. Last April we started a pre- 
school clinic, held weekly with the well-baby clinic. This proved popular, 
and especially to the 4-year-old, who loves to play with the toys and take 
home a book (health literature), or a contest to do, like his big brother 
brings home from school. In January a special clinic was held for those 
6-year-olds starting school. At this the Medical Health Officer gave a. 
very instructive talk on the " Health problems of the child from 2 to 6 
years." At one of the clinics last year Dr. Thompson gave an extremely 
valuable lecture on "The Care of the Teeth." 

In this district we have a fairly large Chinatown; so last April a 
well-baby and pre-school clinic was established. This is held every month 
in the "hinese Mission, and we have been very fortunate in having 

24 



Dr. Gung, of Victoria, with vis; twice he examined the children and gave 
an address to the mothers in their own language, as they can speak little 
or no English. This is a great handicap, but we have partly surmounted 
it, having received from China many Chinese posters and pamphlets on 
health, which are read and explained by Mr. Chan, the local Chinese 
missionary. A sample layette has also been obtained and is used for 
demonstration. 

Home-nursing classes have been well attended during the winter 
months, with an increase over the previous year. 

The Girl Guides were given a series of lectures on the pre-school 
child, enabling them to obtain their proficiency badge for "The Child 
Nurse." They also wrote an examination for their " health badge." 

Another group receiving health instruction are two C.G.I.T. groups 
of about a dozen girls each. These talks on health are given under the 
title of " Beauty Culture," which proved very enticing. Included in the 
lectures are several demonstrations of the more simple nursing pro- 
cedures. 

The plan for giving hot drinks to the children at the Indian school 
who bring their lunch is now realized. A dozen children or so each day 
have a hot cup of cocoa to warm them and to make their cold lunch 
more appetizing. Some of these children come 5 miles into school, so 
this hot drink is a great boon. 

Muriel Upshall, R.N. 



KEEPING A NEW YEAR'S RESOLUTION. 

My third year in the Similkameen has just begun. The past two 
years have been eventful and on the whole very pleasant. I hope this 
year will prove equally so. 

The first year I had to reorganize considerably, as the Indian work 
was new. The time was ripe for putting on a campaign for immuniza- 
tion against diphtheria, so " toxoid " was administered to the school and 
pre-school population and later a vaccination clinic was held and the 
regular bi-monthly baby clinic was put into effect. These things had been 
planned before, but never put into action. 

I have now got the work down to a regular system. Each day has 
its duties, leaving a margin to take care of emergencies. I have had time 
to observe and to know my district better. Whether it improves on 
acquaintance is better left unsaid. But love for humanity as a whole 
and toleration for all must ever be a requisite of a Public Health Nurse. 

Beginning with the school-work, I visit Keremeos School twice a 
week and Cawston once, and get names of absentees on each visit. I 
inspect each room once a week for cleanliness, skin-disease, and signs of 
illness. On the whole the children are very particular about personal 
hygiene. Skin-disease is practically unknown. 1 found two cases of 
scabies last year; none this year. Every child owns a toothbrush and 
uses it too. The attendance is very good. December and Jan arv are 



our bad months for illness, mostly colds. Last year (1930) we had to 
contend with a bronchial cough. This year (1931) there was a nasty 
sore-throat complication (septic throat). 

We made a New Year's resolution for 1932 that we would do all in 
our power to have no colds during the year. All our " health talks ,; 
lead up to this aim. Children with a coryza, cough, or sort throat must 
be excluded until symptoms have subsided. We call this our " one-year 
plan.'' It seems to have created new interest and I try to get up a dis- 
cussion when possible. If we can get the present school population to 
think rightly and rationally about health, they may not fall victims to all 
the propaganda and fads for corrections of defects and how to live right, 
published in the daily papers and broadcasted all over the land. 

I am also going to read and discuss the Provincial Health Report 
in the school. It is splendid reading, so absolutely sane and expressing 
so much forethought and action. 

Regarding the correction of defects, such as enlarged tonsils, in 
most cases it is lack of funds which hinders the correction being made. 
If we had a resident physician, arrangements could be made, I believe, 
but we are a bit handicapped there. I am hoping to be able to make 
arrangements for a tonsil clinic in June, if possible. For this, I must 
have the co-operation of the doctors in Princeton or Penticton. 

Most of the eye defects have been seen to. We are fortunate in 
having a good eye and ear specialist in Penticton. Several children have 
had teeth attended to. The children in the primary-room and many of 
the pre-school have extremely poor teeth, but their permanent teeth seem 
quite good. I consider that lack of prenatal care accounts for most of 
these poor deciduous teeth. 

I carry on the well-baby clinic every two weeks. The babies and 
p re-schools are weighed and measured. We discuss food formulas and 
the general hygiene of the children, habits included. During the winter, 
attendance is not so good on account of weather and roads. One mother 
walked 4 miles to attend the clinic on December 11th. I took her back 
in the car. 

I hope to have a doctor in attendance at one of our clinics in the 
spring, mostly for the sake of the pre-school children who begin school 
in September, and if possible have defects corrected at once. 

My prenatal cases reported quite early this year. We have had 
several new babies. I had, all told, five confinements at home. Two of 
these were Indians. All other obstetrical cases went to hospital. In 
case of confinement, where a physician is not in attendance, I insist that 
the mother go to the doctor for her sixth week examination — all except 
the Indians of course. 

The prenatal letters are received by all prospective mothers. I also 
send in the names for postnatal advisory letters. These are read and 
appreciated. One mother (a primipara) has been receiving a lot of 
advice from friends and neighbours about the care of the baby. She says : 
" I pay no attention. I do as the letters from the Department tell me to 
do." She has a lovely baby too. 

26 



We have not had much illness. There were two cases of whooping- 
cough, one scarlet fever, and one German measles. Regarding the report- 
ing and isolating of infectious diseases, the people are excellently trained. 
We had one case of threatened mastoid, one haemorrhage in the new- 
born, and one strangulated hernia. Also a serious case of a foreign body 
in the eye, two cases of cerebral haemorrhage, and convulsions of doubtful 
origin. All the rest have been minor illnesses, symptoms subsiding in a 
few days. 

I have splendid help from the doctors in Princeton and Penticton. 
The aloneness of being alone is sometimes a little overpowering. The 
roads this winter have been so slippery I have had to cut down some of 
my trips to the Chopaka Indians. It is 84 miles return to Chopaka, and 
storms in the mountains come up so quickly. I ford the river whenever 
possible, cutting off about 40 miles. The Similkameen River is rather 
treacherous and it is easy to get stuck in it. This has happened. to me 
twice. The second time I had a. passenger and we waded into the river 
and pushed the car to land. We arrived home soaking wet, but thankful 
to get out so quickly. 

I enjoy the work among the Indians and can see a little progress. 
The tuberculosis problem is some task there. Active cases are cropping 
up here and there all the time. I do my best to carry out the " cure ' ; 
in the home. The Indians know that the disease is contracted by con- 
tact, and I must say the Indian people keep away from the infected home 
remarkably well. They will not let the children in at all. I am getting 
permission from the Indian Agent to have all contacts and suspects 
examined by Dr. Lamb. I have obtained co-operation from the priest in 
enforcing the cure, such as better food and rest. There is much improve- 
ment in the housing. There are very few houses left now with only one 
small window which does not open. Every child is taking C.L.O. during 
the winter months. Some of the underweights have come up wonder- 
fully. So there may be hope for them yet, but it is sort of doubtful, 
and we can only hope that " Somehow good may be the final goal of ill.'' 

B. Thomson, R.N. 



THE POSSIBILITIES IX A WELL-COORDINATED PLAN OF 

DEVELOPMENT. 

Variety is the spice of life, and what life could afford more variety 
than the life of a rural Public Health Nurse. We encounter something 
new each day. Our range of activity, already very large, increases 
constantly — so much so, our enthusiasm is never allowed to wane or 
grow old. 

Much has happened in the six months that we have been here. In 
September three days were spent at the local fair, when we held a baby- 
show and better-baby competition, Dr. J. R. Davies taking the difficult 
part of a very popular judge. Two silver cups were awarded — one to a. 

27 



baby of 6 months, the other to a child of 3 years. Besides, there were 
twelve medals given to school-children 98 per cent, physically fit. The 
interest shown at the fair was full reward for any hard work it may have 
occasioned. It afforded us a splendid opportunity to meet not only our 
local mothers and children, but also a large number of citizens who are 
keenly interested in our work. Unfortunately we haven't any well-baby 
or preschool clinics operating here, but we do have weighing-stations in 
charge of the Provincial Health Xurse, where the children are weighed 
and advice is given to the mothers. We find that these mothers are very 
loyal supporters. They place a great deal of confidence in the nurse and 
her work, and eagerly follow out her instructions. A remark recently 
made by one of our mothers will serve to illustrate this confidence. 
A six-month baby, whom we had not got in touch with, recently died in 
a convulsion. The remark I heard was : " If only that baby had been a 
regular attendant at the weighing-station, that tragedy may never have 
occurred." 

School-work includes monthly inspection of all grades, weighing of 
underweights. It will be interesting to note that the percentage of under- 
weights from September to December decreased from 58.2 per cent, to 
27.4 per cent. Health talks and health stories are given monthly in 
collaboration with the class-room lessons. Last but not least, there are 
the home-school visits which afford an intimate contact between the school 
and the home, and it is here that we endeavour to instill into their minds 
the gospel of prevention. 

Much credit goes to the Kinsmen Club for the activity they have 
shown toward child-welfare work. During Christmas they conducted the 
T.I3. seal campaign, and as a result have a fairly large sum of money 
collected to be used locally for preventive work. During the past month 
they donated to the Chilliwack Central School a silver shield to be com- 
peted for by all the grades. The rules of the competition include the 
simple rules of health, and one expects to see a great deal of enthusiasm 
stirred up when each individual student works for the shield. 

Here I must pay tribute to the school-teachers and School Boards, 
who have co-operated so heartily in the health-work among the children. 
In Chilliwack we are proud of our schools, our teachers, our children, 
and our former nurse, Miss Peters. 

At the hospital we conduct an eye, ear, nose, and throat clinic. 
A specialist from New Westminster visits us once a month. The nurses 
arrange the time schedule for the patients and assist the doctor. The 
clinic was an experiment started by Miss Green and much good work 
has been done, as it brings to the children here the services of a specialist. 
Since September, 1931, forty-three cases have been examined. 

The saddest and most discouraging part of our work here has been 
the measles epidemic. It reduced our school attendance from the high 
percentage of 97 per cent, to less than 50 per cent. There was lack of 
understanding among the four doctors here, which led to lack of co-opera- 
tion towards preventive work. There was no uniformity of action, and 
the whole problem became so involved that it was necessary to call for 

28- 



Dr. Young's assistance. However, the damage had been done, but it may 
not all have been in vain. In all probability it may result in the estab- 
lishment of a full-time health unit in the near future. Chilliwack is 
fortunate in having many active women's organizations and we are rely- 
ing upon these organizations to work out the financial solution of a full- 
time Health Officer. 

Education of the public would appear to be the keynote to the 
future success of preventive work. By giving talks to the various organ- 
izations en masse, besides the individual contact with parents when doing 
home visits, one can accomplish a good deal, but adults are slow to learn 
and it requires persistent repetition to make new ideas take the place of 
old ones. We are greatly indebted to Dr. Amyot, who, during the winter, 
has given us three very enlightening and valuable lectures. 

Last but not least, we must express our sorrow on hearing that the 
Refresher Course will not be held this year. We had counted so much 
on this valuable opportunity of having our many little problems solved. 
May finances soon return to normal conditions! 

Geraldine E. Homfray, R.N., 

Chilliwack. 



HOW IMPETIGO CAN TRxVVEL! 

In some of our rural schools this year, following the summer holi- 
days, impetigo was quite prevalent. Within the first month, by excluding 
each case until a complete cure was effected, the condition was wiped out. 

However, in one school this was not accomplished without some 
difficulty. At the beginning of the term there were several mild cases, 
but, by the third week, of the fifty-two pupils only four were excluded 
through impetigo. The same week saw the readmittance of two of these. 

Nevertheless, when I visited the school in the fourth week, the num- 
ber of absentees was astounding. Another thing which surprised me 
was a letter which had been sent to the principal. A mother stated that 
she was keeping her two children at home until the school was certified 
free from infection. 

I hastened to make out my list and start out on my rounds. The 
first home I visited was the one from which the letter had been sent. 
I might mention here, this family had recently come to the district and 
were unaware of the nursing service. The mother appeared to be a very 
practical, sensible individual when she explained to me why the children 
had been kept from school. The preceding week the two youngsters, 
aged 6 and 8, had come from school with the tale that there were many 
children in the school suffering from " infectious sores." Such circum- 
stances were to the mother naturally rather alarming. 

Investigation showed that several days previously the principal had 
assembled the school and had imparted advice regarding impetigo infec- 
tion. The import of her talk seems to have been that the school was 
infested with what she termed " infectious sores," and to protect them- 

29 



selves the pupils were to shun any one with sores of any sort, and to 
wash frequently and well with Lifebuoy soap. 

This information was, I am sure, given with the best intentions, but 
the results were very far-reaching and, from our point of view, most 
unsatisfactory. To begin with, the statements were anything but accu- 
rate. Impetigo was not rampant in the school — there being but two 
cases, both of which were at home. The efficacy of Lifebuoy soap may 
be left to the imagination. 

Further, the mind of a 6-year-old certainly could not grasp the 
significance of such information ; nor even that of a child in the second, 
third, or fourth grades. Therefore one can easily imagine the variety of 
stories that were taken home. Such a term as " infectious sores " is in 
itself upsetting, particularly to the layman. 

When homes are as far apart as those in this district, it is rather 
difficult to visit each mother individually and allay her fears by a state- 
ment of fact. This was my problem. I can assure you it was a long- 
time before every one in the district, which, incidentally, is a large one, 
was assured that the school was free from infection. 

Thus the unfortunate zeal of a teacher, supplemented by the mis- 
representation of children, brought about a chain of untoward circum- 
stances. Just another example of that old adage, "A little knowledge is 
a dangerous thing ! " 

Heather Kilpatrick,, R.N., 

Duncan, 



MEASLES. 



Measles is one of the most universally prevalent of the acute com- 
municable diseases, occurring in cycles of two to three years, during 
the winter months. It usually spreads in schools, from where it is 
carried to preschool children and infants. Immunity is obtained by one 
attack of the disease; all other persons can be considered susceptible. 

Measles is spread directly from the patient to susceptible contacts, 
and very seldom by fomites or a healthy person. Discharges from nose 
and throat apparently harbour the causative agent. 

The incubation period is from eight to fourteen days, after which 
the cold or onset stage of the disease is observed, followed in three to 
five days with the rash. The infectious stage is from the earliest sign 
of onset till about seven to eight days after the appearance of rash. 
When preventive measures can be adopted during the cold or pre-rash 
period of the disease, control of the epidemic is reasonably sure of 
attainment. 

From 80 to 95 per cent, of deaths due to measles and complications 
occur in the age-group under 5 years. It can be readily seen that this 
group of children should be protected against the disease. 

Health- workers should impress mothers with the fact that it is 
unwise to allow young children to have measles (to get it over with), 
as it may have a serious outcome. 

30 



Control Measures. — As we have seen from the above, an epidemic of 
measles spreads most rapidly in schools. In January, at one of the North 
Vancouver City schools, a child attended class for half a day during 
the cold or pre-rash period of measles. To this girl nineteen subsequent 
cases of measles were traced, which started an epidemic in the school. 
The nineteen infected children carried it into their homes and naturally 
pre-school cases resulted. 

Where definite contact was known, all susceptible children were 
allowed to remain in school for seven days following their first possible 
infection, and then excluded from class and isolated until fourteen days 
from their last exposure to measles. In this way fifty-one children 
developed the disease while isolated at home, thus preventing the further 
spread in the schools and elsewhere. 

Periodic visits were made to all homes having contacts or measles 
cases. Instructions re spread, details of isolation, nursing care, etc., 
were given to each parent; the danger in allowing young children to 
develop the disease was emphasized, and harm from complications was 
pointed out, also the parents advised to call the family physician. In 
many homes the results were very gratifying, while in others, where 
instructions were not heeded, the outcome was as bad as was expected. 

A great deal of time and energy was expended by the staff of the 
Health Unit on this work with the idea of training parents and others 
in modern preventive measures. It is hoped that this work will bear 
fruit in future epidemics of perhaps a more serious nature. 

The school-teachers, principals, School Boards, physicians, and many 
of the parents, by co-operating with the Health Unit, assisted to a great 
extent. Due to this help 99 per cent, of all cases of measles were 
reported. 

Elizabeth Lowther, R.N., 

North Van couver. 



HURRAH FOR A BOWL OF SOUP! 

The big achievement, if one may be permitted to call it such, in 
Kelowna this past school term has been the establishment of a soup- 
kitchen. This project has been on its way for two years now, but this 
year saw its actual arrival. 

The undertaking was financed by the teachers, but some outside 
financial contributions were received. The pupils brought their dona- 
tions of garden produce, and potatoes, onions, peas, rice, etc., descended 
upon the school in almost overwhelming quantities. The kitchen was 
set up in an unused room in the girls' basement of the Elementary School. 
A woman was hired to prepare the hot drink, cocoa, vegetable, or milk 
soup, as the case might be. 

Opening day was held early in November and we are planning to 
keep operating until the end of March. The number of children varies 
from 80 to 100, and of these 70-odd are "free" cases. Those who can, 
pay 3 cents a day. 

31 







The personal thanks of some of the parents and the grateful looks 
on the youngsters' faces has more than compensated us for our efforts. 

The relief-work has increased tremendously within the past few 
months. The town has its own Central Relief Department and the 
schools are kept in constant touch with them. Through them clothing, 
food, medicines, toothbrushes, exercise-books, and pencils have been given 
out to the worth v cases in the schools. 

The past week has been a very busy one, with vaccination clinics 

much to the fore. The response of the public to these clinics has been 

most gratifying. Approximately 525 school-children, 35 adults, including 

teachers, and 44 pre-school children and infants have been " done " up 

to date. Public-health teachings are showing their mark slowly but 

surelv 

* v ' Edith W. Tisdall, R.N., 

Kelowna. 



PUBLIC HEALTH IN KAMLOOPS, B.C. 

Another year has flown past very quickly, in spite of many adverse 
circumstances. Most of us have learned many necessary lessons of 
tolerance and understanding in dealing with the ever-present question, 
relief of our needv. 

Kamloops has suffered, as all cities have. It is through the sympa- 
thetic support of the Red Cross Society, City Council, and Provincial 
Department that I have been able to obtain adequate relief for many 
families. The Red Cross Society is doing a wonderful work, especially 
in giving relief. The following particulars help one to realize just what 
was done last year : There were 8,752 garments given to 225 families, 
and 1,798 quarts of milk, also 36 bottles of cod-liver oil. This gives some 
idea of the activities of this splendid society. The lady in charge of 
this relief -work is Mrs. R. L. Johnstone. No words could possibly convey 
what we, of the Red Cross, and all who come in contact with her sympa- 
thetic personality, wish to express. She gives daily of her time, intelli- 
gence, and sympathy to all who desire her help. She is much loved by 
all. We are also most fortunate in having Mrs. J. E. Fitzwater as our 
president, who is always ready with her wise judgment and understand- 
ing. It is indeed a privilege and great pleasure to work with these two 
remarkable ladies. In addition to their many activities, they are my 
right-hand helpers at our Red Cross well-baby clinic. These we hold 
fortnightly. Last year we held thirty clinics and we were much encour- 
aged. The mothers showed a great deal more interest. They come more 
regularly and are more willing to accept the advice that I give them. 
Following is an account of the work accomplished during 1931 : — 

Number attending clinic : Babies, 202 ; adults, 220 ; pre-school, 53 ; 
total, 475. The previous year the total attendance was 234. So you see 
we had an increase of 241. 

There were: New babies, 46. Breast-fed, 32; artificially fed, 12; 
supplemented, 2. Number of babies registered, 72. 

32 



Visits to homes: Babies, 78; p re-school, 73; total, 151. Advice to 
expectant mothers, 20; advice given per telephone, 118; advice given 
per letter, 12. 

It may interest my readers to know that all advice given at these 
clinics follows the teachings of Sir Truby King. It should not be 
necessary to explain who he is. All who are interested in the modern 
welfare of mothers and babies know of this eminent man from New 
Zealand, whose intelligence and research-work for the past twenty-five 
years have made him beloved throughout the world. I am delighted to 
see that, at last, Canada has a mother-craft training-school, where nurses 
can be trained along his lines of simplicity. This was started last year 
in Toronto. Miss Satchel!, who is in charge, I hear, is doing wonderful 
work. Sir Truby King has been invited by the Canadian Government 
to visit Ottawa this year. I only trust his health will enable him to do so. 

The Lloyd George School still continues its good work in connection 
with the Junior Red Cross. They held their annual Primrose Tag Day 
last April and collected $130.50, which is to be used for our Dental and 
Medical Fund. Since starting this fund in 1930 they have assisted 
thirty-four children in having defects corrected, mostly dental work. 
They sent |3 to the Hamper Fund at Christmas-time. We now have 
174 members. 

As usual, I assisted with the Christmas Hamper Fund. This year, 
owing to the condition of the times, our work was greatly increased. 
I made many investigations for our committee. Our list of needy seemed 
never-ending. We sent out 147 hampers in all. They were wonderful 
ones, too. In addition to food, they included warm underclothes, stock- 
ings, and many goodies. It was splendid to see the many public-spirited 
women who gave of their time so cheerfully to help cheer their fellow- 
citizens at this time. Our Chief of Police, Mr. Anderson, who was the 
chairman of the committee, was ever on hand with a cheery word for all. 

Our school-work goes on as of yore. It is hard to find anything new 
to say about that part of my work. To me, the most interesting feature 
was organizing my Little Mothers' League classes in the three Grade 
VIII. 's of our Junior High School. It was a great pleasure to teach 
these young girls the most essential of all studies, in my opinion — the 
responsibilities of motherhood. The results were very good. Seventy- 
five per cent, of these girls passed with 60 per cent. I gave these lessons 
along the lines of the simple teachings of Sir Truby King. Many mothers 
told me of their appreciation of these classes. The same lessons I gave 
to the Girl Rangers. I completed these classes by giving my pupils a 
lantern-slide lecture, depicting interesting features of my work in Canada 
and New Zealand. By these simple means one is able to present to one's 
pupils a brief idea of the greatness of the teachings of Sir Truby King. 
Certainly, we Public Health Nurses are most privileged to have this 
contact with the children of to-day, in all stages, from the prenatal care 
of the mothers, following the interesting development of the baby to 
pre-school age. Why, in no time, we find our clinic babies in our first 
grades at school. Then on to Junior High School. What more interest- 

33 



ing profession could any woman desire? As I say, so many times, it is 
not only weighing and measuring and peeking into Johnnie's and Mary's 
mouths and ears, and teaching them the essentials of health, but, may 
I humbly say, helping to mould their characters and helping them to 
realize what the " Spirit of Canada " really stands for. I would like 
every Canadian child to have heard the stirring address which Hon. R. L. 
Maitland, of Vancouver, gave to our Canadian Club. Our youth is so 
precious. May we more and more find men and women to lead them 
mentally, physically, and spiritually to the best of all things that mean 
so much to the future of Canada. 

Olive M. Garrood, R.N. 



PUBLIC HEALTH SERVICE SOUTH OF THE 
PEACE RIVER, B.C. 

" On to the Peace! ' is the slogan that has been drawing many new 
residents to this part of the country. The writer journeyed five months 
ago into the Peace River District, being sponsored jointly by the Red 
Cross and the Provincial Board of Health. The Peace Block is a vast 
rolling country, with huge cut-banks gouged into it. The banks are 
covered with golden birch. Patches of stubble surround the clearing 
of the homesteader. There he lives in a little log cabin, often with only 
a dirt floor. His nearest neighbour is a. mile away at least — usually 
farther. 

I have charge of twelve schools and their districts, scattered over 
mountains and along the banks of streams, in an area of 120 square 
miles. Transportation is difficult, as the weather is likely to change 
unexpectedly from 60 below to above zero. The roads may be lost beneath 
heavy snow and ice, or submerged beneath floods of water. The thick 
gumbo is almost impossible for a car, and is bad even on a horse. 

Last week I had to take a maternity case into Pouce Coupe, to the 
Red Cross Hospital. It is only 40 miles and the roads had been cleared 
of snow for the mailman, who comes through once a week. 1 keep my 
car 3 miles from where I live because of the bad drifts. It was necessary 
to harness my team and in the open cutter drive to the place where my 
car is kept. Picking up my patient, we drove into Pouce Coupe in the 
car. It had started to snow before we turned homeward, but by pushing 
ahead we managed to get back within 8 miles of my home, when the car 
stuck in the snow in a field. I had to walk 2 miles back in a real blizzard 
to the home of one of mv committee-men, who drove me to my own team. 
The drifts were so bad by this time that we could not keep to the road. 
We upset three times into the snow in weather 00° below zero! We were 
lost in a woods with which I am perfectly familiar and could not find 
the gateway to our own place. It was 3 a.m. before we reached home. 
Just a day's work in the Peace! 

The work as a whole has taken a great hold on the community. 
I have twelve committees, one in each district. Each has a representative 

34 



on the Central Committee, which meets once a month. They work hard 
and are taking a keen interest in public-health matters. They all want 
to help toward the development of health services in other parts of the 
country in time to come. 

This is a country of no water, unless you are lucky enough to live 
near a creek or river. This presents a real problem to the school trustees, 
as well as to the parents, to see that there is a sufficient water-supply 
to meet the needs for both drinking and washing. Since most of the 
water comes from the melted snow and ice, we have started giving iodine 
to many of the school-children to prevent goitre. This is done under the 
direction of our school doctor. 

The most interesting event was the " family " clinic which I ran in 
five districts. Each family was taken as a unit and all the children — 
infant, preschool, and school — were examined by Dr. Becworth. Many 
of the mothers travelled long distances to reach the clinics, where they 
were greeted by members of the committee who assisted with the weighing 





M 








^m>, . ^jp 


mM 








*:' 




/• 




■■Bflfl Ek. 


^ J*. '^ 





" ON TO THE PEACE.' 



and the taking of records. The mothers took a great interest in the whole 
programme. For many of them it was their first trip in years farther 
than a few miles from their homes. We are planning to complete all 
twelve districts in this way and should have some interesting statistics 
when we are through. 

I hope that the day will soon come when we have more Public Health 
Nurses up here. There is much to do. People are gradually filling in 
all the farm lands. This part of the country has wonderful prospects 
and a fascination all its own. But, like all the Northland, it is a stern 
master and demands stamina and courage in all those who choose to 
settle here. In a land where all the news and messages travel by 
"moccasin telegraph" and neighbours are scattered, a real community 
spirit of helpfulness and patience must develop. 

Nancy E. Dunn, R.N. 
35 



THE CHEST CLINIC IN A RURAL COMMUNITY. 

District-nursing has its exciting moments ; for instance, through the 
mail may arrive any day, a miserable-looking post-card advising you that 
a visit from the chest specialist is to be precipitated soon. You may 
get a week's notice; you may only get a few days' warning; but, never- 
theless, the search for T.B. patients and contacts is forthwith on. The 
announcement to this effect is duly placed in the local paper and tele- 
phones begin to ring incessantly for appointments. On occasion some 
kind soul will inquire if they can be vaccinated at that clinic ! With 
infinite patience you explain that the clinic is solely for those with chest 
troubles — and the receiver is hung up the other end of the wire with an 
amazed " Oh ! " Another patient " reckons it's a good thing to have a 
medical examination every so often, so I'd better see the doctor at the 
clinic. You know, nurse, all the doctors are advising us to be examined, 
and so are you nurses too ! " 

Finally, however, the time-schedule is made, fifteen minutes allotted 
to each patient, and all are given a definite time at which to report at 
the clinic. Patients, miles away, are assured that a nurse will call for 
them and bring them in in time for their appointment. 

Soon another phone call: " Miss Peters speaking; we are all ready," 
and oft' we fly. Dr. Lamb, that genial chest-examiner, greets you with 
a big smile as though you were his best friend, and you feel that it is a 
privilege to help him make his clinics a smooth-running success. Both 
he and Miss Peters are charming and have, seemingly, an inexhaustible 
supply of patience and good nature ; and even though they make many 
extra chores they are more than worth while, and we need them very 
much in our preventive programmes. 

For the duration of the clinic, cars rush madlv to and fro in an 
effort to keep schedule and overlook no one. About the last afternoon 
of the clinic we ^ct a long-distance call about 13 miles away: "Nurse, 
there's a poor old man living alone out here who does nothing but cough 
and spit all day. I think it's something wrong with his bronchial tubes; 
could you come and see him?'' We assure the caller that we will do 
so immediately, and, with a feeling of dread, we tear off, only to bring 
said old man with his " bronchial " tube disorder to the hospital to die, 
an advanced case of T.B. who has had all the neighbours doing things 
for him and consequently exposed to infection. Needless to say, the list 
for the next clinic is already long with names of " the poor old fellow's " 
contacts ! 

Bertha Jenkins, R.N., 

Duncan. 



HEALTH-WORK IN ARMSTRONG. 

In these times of depression Armstrong is possibly a little better off 
than most places. By a little forethought and planning every one should 
have enough food and fuel. Various local societies have co-operated in 

36 



providing clothing for those who need such aid. Despite the hard times, 
we have fewer malnourished children than ever before, and on a whole 
the children are well clothed. Milk is provided for those who need it 
and cannot obtain it at home. 

Our school attendance has been good. The days lost from communi- 
cable disease were less than any previous year. It may have been good 
luck instead of good management, but I really believe the majority of 
people are beginning to be. a little more careful about reporting infectious 
cases. What a slogan for any school is that quotation, " To cure is the 
voice of the past. To prevent is the divine whisper of to-day." 

Speaking about prevention, about 50 per cent, of our pupils have 
had toxoid and 75 per cent, have been vaccinated for smallpox. The 
vaccination has fallen off a little since the School Board has discontinued 
the free clinic, but we try to keep up the good work by having the doctors 
vaccinate the beginners at the preschool clinic in June. This they do 
for a nominal sum. 

One of our educational activities is the home-nursing and first aid. 
Last year our boys' first-aid team won the Leonard shield, the Provincial 
trophy. This year we are entering a boys' and girls' first-aid team and 
also a girls' home-nursing team. The competitive spirit seems to stimu- 
late the pupils and much greater interest is taken in the work. 

To interest the pupils in their own appearance and that of their 
surroundings, a shield is given every month to the class receiving the 
greatest number of marks. Marks are given for the cleanliness and 
general appearance of the pupils, class-rooms, desks, floors, lobbies, and 
also for the posture of the pupils. A general check-up seems to be neces- 
sary to keep things to a high standard. 

We are indebted to Dr. Ootmar for our exhibit at the Provincial 
Interior Exhibition held in Armstrong last September. The exhibit con- 
sisted of over 100 plates showing the various foods and their vitamin 
content. Booklets were given out explaining the exhibit and some one 
was on hand to impart any information required. We also had quite 
an array of pictures and posters and other health literature was dis- 
tributed. Altogether the exhibit was an educational project and caused 
considerable interest. 

■ 

During the past year there has been a decrease in the number of 
physical defects remedied, but as soon as prosperity comes around the 
corner we hope to have many things done. 

Most of our pupils have good health and care. Every day I feel like 
paying a tribute to the mothers who send several clean, well-fed, and 
clothed children to school. When I think of their ceaseless work and 
care my part seems very small in comparison. 

Before closing I should like to mention my appreciation for the 
co-operation and* help I have received from the doctors, the School Board, 
the school staff, the Provincial Board of Health, and various local 
societies. 

P. Charlton, R.N. 
37 



VIEWS UPON EDUCATION. 

Not so very many years ago, education — of any sort — was available 
only to a very limited few; those few, of course, being the children of 
the upper classes. 

If a child of poor and illiterate parents exhibited any special talent 
he usually got a chance to develop it, through systems of patronage or 
scholarships. In these days of compulsory education we have talented 
children and those whose mentality is extremely poor, struggling along 
in the same class-room to obtain an academic education. 

Education every year is becoming more and more of a drain upon, 
our Government funds, and the aim of education is supposed to be: 
" To prepare our children for good citizenship." Now, for the welfare 
of our country, we need people trained to perform all the various and 
varied duties which go to make up the smooth-running of the machinery 
involved. Why, then, force academic education upon a large percentage 
who have no aptitude for it? If we have a right to enforce " compulsory 
education " from the ages of 6 to 15, have we not also an obligation to 
give the child the kind of education for which he is fitted, both mentally 
and physically? 

The cost of technical schools, of course, would be enormous; but 
would it not be cheaper in the end to give the child the education for 
which he is fitted? We, in the schools, know by the time the child is 
8 or 10 years of age whether or not he is fitted for an academic education, 
and is there much use in forcing a child through such an education up 
to the age of 15 when he cannot grasp it? 

As it is at present, we turn a child out of school at the age of 15 
and he is absolutely unfitted for employment of any sort. If, say, at 
the age of 10, a child of less than average intelligence were given the 
chance of learning a trade, and could be given special training along 
such lines, then at the age of 15 or 17 he could be turned out as a trained 
worker, ready to make an independent living. 

Let us glance at the psychology of our present system and the moral 
effect enforced academic education has upon the backward and dis- 
interested child. He plays truant as often as he can manage it ; he acts 
as a disturbing influence in the class-room amongst the more studious; 
he is a rebel against being forced into something for which he has no 
inclination; and very often, his criminal instincts are well developed 
before he reaches the age when he can leave school without having the 
truant officer sent after him. 

It is my opinion that in the long run the Government would be 
money in pocket, we would develop a better citizenship, and the child 
would be healthier — mentally, morally, and physically — if given the type 
of education for which he is best fitted. 

This may not be possible of accomplishment for the present genera- 
tion, but I think it would be a bright goal to look forward to for the 
future. 

Winifred E. Seymour, R.N., 

Fertile. 

38 



WHAT I HAVE LEARNED ABOUT THE HINDU PEOPLE. 

Arriving in Yonbon, a milling town on Lake Cowichan, about six 
month ago, my knowledge of Hindu customs was extremely limited, and 
my knowledge of their language more so, while their ability to under- 
stand me was about on a par. 

One day, while making visits in our Hindu settlement, finding it very 
hard to get my ideas over to them and almost ready to give up, I asked if 
there was any one amongst them who could speak English. The Hindu 
man I was talking to said " yes " and dashed off. While I was wonder- 
ing if he knew what I was talking about he returned with a young Hindu 
man who had just completed a five-year course at the University of 
British Columbia. Need I say he was more than welcome, and ever since 
has been more than helpful when I am in difficulties. 

He has taken every opportunity and considerable time in enlighten- 
ing me about Hindu modes, methods, and ideas, including diet and 
religion, etc., which I thought would be interesting to pass on. 

To begin, the origin of the term " Hindu.' 7 A Hindu is one who 
professes to be an adherent of the ancient religion Hinduism. This was 
the religion of that branch of people known as Aryan, who first migrated 
to India some 4,000 years ago. During the following centuries the 
religious beliefs of the majority of the survivors of these people have 
undergone radical changes, although a large majority of the people of 
India still follow the original beliefs, modified perhaps. These are the 
Hindus of to-day. 

We have adopted the word " Hindu ' as meaning any native of 
India in our midst, whether he is a Sikh, Hindu, Buddhist, Mohammedan, 
Christian, or Atheist — so long as he wears a beard and turban. The most 
appropriate name for them is Hindis, which means an inhabitant of Hind 
or India. 

Most of the Hindus in Canada are natives of the Province of Punjab, 
and my friend informs me that they are as much Hindu as Gandhi is an 
Eskimo! for they are mostly Sikh by religion. At first they objected to 
being called Hindu, but they have gradually become accustomed to it, 
and to all intents and purposes they are, to us, Hindus. 

In Punjab they were originally farmers, known popularly in the ver- 
nacular as " Jats." They owned the land they cultivated and are an 
influential and esteemed class of people. It is just the odd one or two 
of a whole family who have migrated to this country, leaving the others 
with their lives of hard work and plenty of freedom, which has made them 
the acme of physical fitness and robustness characteristic of them. 

I was curious to know why they left their people and land to come 
here, where the climate is so different, and it appears that there were 
some Punjab police and army men stationed in various parts of China. 
When they received superannuation from the Government, instead of 
going back to their native land they set out to try their fortunes in 
Canada. Arriving here, they managed to secure work on railway- 
construction gangs and sawmills in this Province. Being industrious, 

39 






they saved a few dollars, which seemed a lot of money to what they had 
made in China or India. Naturally they told their friends at home about 
the place where they could make their fortunes, and by 1910 there were 
4,000 of these people among ns. Owing' to a later immigration policy in 
Canada, very few more have entered the country, while a lot more went 
back to India, with the result that there are just about 900 in Canada — 
150 women and about twice as manv children (?). 

Most of the Hindu men, being- unskilled labourers, have remained 
about lumber-mills ; some of them have returned to their farming ; some 
of these have become quite successful around the Fraser Valley, Kelowna, 
and Kamloops. The Hindus of this community are very fit, tall, broad- 
shouldered, and well developed, while the women are anaemic, mal- 
nourished, and lazy. The children are rickety, thin, and pale. The 
mothers are, however, anxious to have all defects corrected and are very 
good about carrying out our advice to the best of their ability, but the 
wages of their men are inadequate to provide the necessary meals, etc. 

The diet of the Hindu people has always interested me, and on 
making my rounds I have found the women busily cooking queer-looking 
pancake things, the flapping of which is so rapidly done by bare hands 
that I have often been fascinated. They call these cakes " rotice," the 
rest of the diet being mostly highly seasoned vegetables, green vegetables, 
milk, butter, and eggs. The average man eats at least half a pound of 
butter daily, accompanied by a quart of milk. Very little meat is eaten — 
no beef, a little pork or chicken. They drink thickly boiled tea and over- 
proof rum — a habit acquired during the war ! 

Their religion, the Sikh, was founded by Nanch during the fifteenth 
century and is very simple : Unity and Omnipotence of God ; brotherhood 
and equality of man; unselfish service to others; sincerity and purity of 
life. What could be better? 

The fact that nearly all Hindus are named " Singh " has often piqued 
one's curiosity, so I discovered that the last leader of Sikhism, owing to 
existing conditions in India, bound his disciples into a martial brother- 
hood for purposes of self-preservation as well as to defend the poor 
and defenceless. Anybody could join, and all who joined were duly 
initiated and give the name of " Singh," meaning " brave and strong."' 
He thereby relinquished his caste, class, or creed, and vowed to conform 
to the rules and regulations, one of which was that he would not " take 
off, cut, or otherwise mutilate even a single hair of his body." Hence 
the beards and heads of long hair! The colour of the turbans is black 
usually, which colour was adopted during the Sikh Temple Reform Move- 
ment which occurred in 1921, when a number of the volunteers were 
murdered in cold blood by their priest. This was a sign of mourning 
and protest. The Government tried to ban the black turban, but this 
prompted the Hindus or Sikhs to be contrary, and eventually the black 
became a symbol of deep religious convictions. Changing customs in 
general over the world has caused the rigidity of even this faith to relax, 
and those who have courage conform to Western ideas, and shave; this 
does not alter their standing in any way, although, if a trip to India is 

40 



contemplated, the beards are allowed to grow again, more because of the 
adage, " When in Rome do as the Romans do." And in India a clean- 
shaven Sikh would be as much out of place as a fully bewhiskered and 
turbaned one is here. 

The social life consists mainly of their religious services held in 
temples in different parts of the Province. Everybody gathers there to 
pray, sing, and eat together, and on the birthdays of their teachers, called 
" Gurns," they have special get-togethers of feasting and rejoicing. 

I have enjoyed working amongst the Hindus here in Youbou, because 
they are very co-operative and appreciative, and some day, perhaps, one's 
teaching will bear fruit and the youngsters here given a chance to become 
the fine physical specimens their fathers are. 

Velma Miller, R.N., 

Youbou. 



THE EFFECTS OF THE DEPRESSION ON 
PUBLIC HEALTH. 

The past two years have brought a great many changes in the 
economic world, and we, as Public Health Nurses, have had a great 
number of new lessons to learn. 

When a financial crisis occurs, the trend to reduce every unnecessary 
expense is inevitable. Therefore it is a time when the Public Health 
Nurse must more and more prove her value as a teacher and to show by 
her efforts the great need for the continuance of her work. 

The nurse, however, has many aids to help her in time of depression. 
Welfare societies, social bureaus, and relief organizations have developed 
more extensively, and consequently she is able to obtain help for many 
families. Even in prosperity a great number of these families are on the 
border-line, and as people are less charitably minded then, it is often 
difficult to obtain a much-needed aid. Thus, for instance, extra milk 
can be obtained for an expectant mother or young children, and extra 
fuel for families who formerly had to suffer from the cold in order to 
economize. 

Again, when people are in need and asking for help, the nurse makes 
many contacts, which she might not have made otherwise. Often, when 
making a social-service call or investigation, a new prenatal is discovered. 
This happens in so many cases, for the expectant mother will ask for 
help in the interests of her unborn child rather than for herself. This 
is probably one of the reasons why the number of new prenatals opened 
on the nurse's record increases. 

In her home visits the Public Health Nurse has excellent opportu- 
nities to teach and establish ideas, the value of which many families have 
hot had to realize before. Therefore the necessity of having to accept 
these ideas makes the work much easier for the nurse. She is able to 
explain the essentials and non-essentials of diet, and that simple, cheaper 

41 



foods are even better than the more elaborate and expensive ones. Again, 
she can be most helpful in showing how the family budget should be 
arranged, and how economy can be practised without any harmful but 
rather beneficial effects to health. In fact, when the family income is 
low, getting back to a simpler way of living is imperative, and the people 
are in consequence benefited by this knowledge. 

Many conditions, defects, or deviations from health, however, which 
would be attended to in prosperity are neglected. The Public Health 
Nurse here again is the only one who has the interests of the people's 
health at heart. She is able, through the nse of public funds, to see that 
these defects are corrected, and thus the laying of the foundation of 
ill-health, invalidism, and a consequent dependence on society is avoided. 

Above all things, one of the nurse's duties is to help the people to 
help themselves. The morale and feelings of independence are bound to 
suffer when aid is easily obtained. Therefore the nurse can prove most 
valuable in this work of keeping the people hopeful and cheerful. One 
last, thing, the nurse has a duty to herself at this time. Even if some 
of her routine public-health work has to be neglected to help the more 
unfortunate through this crisis, she mnst keep an optimistic view-point 
and look forward to the future. 

Myrtle Harvey, R.N., 

Saanich Health Gentre. 



" FIRST IMPRESSIONS." 

Oh! for the ability to express oneself easily and clearly! When the 
request came to furnish an article for the Bulletin, I said inwardly: 
" What in the world can I find to write about, seeing I have only spent 
a month in this district?' So if this article is very boring you will 
have to excuse me on the grounds of being " a newcomer."' A newcomer 
to Vancouver Island, but not to the Province of British Columbia, having 
previously spent several years in this part of Canada, which I regard as 
" God's country." 

A nurse's life is certainly one of varied experiences and changes; 
perhaps therein lies its fascination. In our profession we have great 
opportunities for meeting all classes, colours, creeds, and races of 
people. 

A year and a half ago I left British Columbia for Northern Ontario 
to accept the post of Travelling Nurse in the Department of Indian 
Affairs. Six months later 1 received a permanent appointment, and as 
I was keenly interested in the work I expected to spend many years 
working among my Indian friends. Alas, like in a great many other 
departments, the work was discontinued as a measure of economy! 

However, every cloud has a silver lining, and soon after my term of 
service expired with the Indian Department I received the offer of my 
present appointment, much to my delight, as I dearly love British 

42 



Columbia. It is quite a change to go from the extremely cold winter of 
Northern Ontario to the mild climate of Vancouver Island ; still more of 
a change to live close to a beautiful city like Victoria after spending 
one's days on an Indian reserve 50 or 60 miles from railway, telephone, 
or telegraph communication ; to exchange travel by canoe and dog-team 
for my present comfortable mode of travelling in a new Ford! 

I felt very sad about giving up my Indian work, but I expect to be 
very happy in this new field of activity. After all, it doesn't really matter 
where one lives so long as one has congenial occupation and kind friends. 

The Esquimalt Rural Nursing Association comprises six districts at 
present — namely, Langford, Coldstream, Shirley, Sooke, Happy Valley, 
and Luxton. At the present time Sooke and Shirley have applied solely 
for the school service of the nurse. The other four districts have the 
generalized service. There are five schools to be visited monthly or 
oftener, as required, with follow-up work in the homes. 

The Esquimalt Rural Nursing iVssociation has achieved a fine piece 
of work — namely, the dental service for school-children. Dental clinics 
are held continuously throughout the year for the purpose of keeping the 
teeth in good condition, examinations being made in all the schools in 
the health district once a year. If the parents desire the necessary work 
to be done by the Association's clinic dentist, special rates are provided — 
namely, at half the cost to the parents of an ordinary visit to a dentist, 
and no charge is made for transportation to and from the dentist's office. 

In addition to the school service, educational work is carried on in 
the homes, child-welfare, prenatal and postnatal service:?, social service, 
and bedside-nursing care as required. At the present time a " home- 
nursing class " is being held twice monthly at Langford for the girls of 
the Junior W.A. who are qualifying for their " nursing badge." 

The nurse in this district is fortunate in having the use of a car in 
good running-order. Just lately there was a phone call : " Nurse, come 

quickly, there has been an accident at N School." 1 can't tell you 

what a comfort it was to have a car capable of answering " A hurry-up 
call " promptly. And so I am looking forward to a pleasant and inter- 
esting year with the Esquimalt Rural Nursing Association. 

In closing, I wish to express my appreciation to the Nursing Asso- 
ciation Committee, to the Provincial Board of Health, to the Medical 
Health Officers, to the teachers and all others who have given their 
assistance and co-operation with the nursing service in this health 

district. 

Olive Ings, R.N., 

Langford. 



"OUT OF THE MOUTHS OF BABES 



>> 



Telling stories to children is something that has had the power to 
strike terror into my heart, stupid as it sounds. With, I suppose, a 
characteristic fear of the unknown, a child's wide-eved stair baffled me 
and I was afraid to appear ridiculous before it. Starting out in public 

43 




health with a groat deal of optimism and a feeling that there was a 
message for childhood in the eight health rules, if it were just put over 
strongly enough, I thought all I had to do was make the rules sound 
interesting and plausible, and a perfect new generation would be the 
result ! 

Then it was that I began to run against snags. 1 found first that, 
like many other nurses, I had no teaching experience; that I hadn't any 
conception of children's mental capacity; and that I didn't know whether 
I was talking up or down to them. My fear of ridicule made me inclined 
to be overcautious, and consequently I didn't make much progress. 

I have discovered since that self-confidence is of first importance, and 
that children, like every one else, take you at your own valuation. They 
are nearly always on the alert to learn, and anything new appeals to 
them. Now that I am a little beyond my original optimism I realize 
that they have known of the health rules since they began school, and 
that I have to search for new ways of presenting them to make them 
attractive. Children have so many interests at school, in games and at 
home, with very variable training and background, leaving gaps of dif- 
ferent sizes to be tilled. The thing to do, then, is to choose between effects 
that can be made en masse and those that are better made individually. 
Usually one reaches the latter through the first. 

Stories have a universal appeal for beginners, who think them won- 
derful, and for Grade VIII. people, who can be enthusiastic in spite of 
themselves. After my first spasmodic efforts I told a story that " went 
over " well and lent itself to embellishment and improvement. My first 
success made me more confident, so I experimented. The story was about 
a little girl whose age made her one with the 6-year-olds. With a black- 
board always near it was easy to sketch figures that were nothing more 
than a dot for head and lines to complete them ; but they were concrete, 
and followed with breathless interest. Three insects, who made speeches, 
all allowed for voice variations hugely appreciated. Who wouldn't be 
rewarded by seeing a roly-poly Japanese boy positively hugging himself 
with joy because a grasshopper could talk! Even the bigger people who 
had considered themselves much too old for a " baby's story " ended by 
laughing, which proved that they had listened. The few sketches left on 
the board were easy to copy, and the resulting drawings made a good link 
for the next visit. 

Every one has, I suppose, their own " typical story," whose success 
is an incentive to trying others. The popularity of this one has given 
me confidence, and now there are friendly smiles in place of baffling stares, 
and I feel that because of the difference I may be making a definite 
impression on the " rising generation." 

Fyvie Young, R.N., 

Duncan. 



44 



THE PUBLIC-HEALTH ATTITUDE. 

Before making the final decision between public health and adminis- 
trative nursing in my last year at University I hesitated a long time. 
Having finished my hospital training, I knew what administrative nurs- 
ing meant, but public health was only a name, and I think I was doubtful 
of the unknown. Since making that decision, the University course and 
eight months at Saanich Health Centre have been teaching me the mean- 
ing of public health. 

If only the word " nurse " had not such a deep-rooted connection 
with the care of the sick, I think the nurse in the district would have a 
much easier time in accomplishing her purpose. Every day the different 
essentials of a hospital and Public Health Nurse become a little more 
apparent, and the need of a completely different attitude of mind toward 
the work is evident. I think, now, that the most important character- 
istics of a Public Health Nurse are an ability to meet people and gain 
their faith and co-operation in carrying out your advice. 

In order to get results in preventive work the nurse must make 
herself a friend of the family, and the time for this is her first visit in 
the home. Once the friendly feeling is established, one may become the 
health teacher and adviser. 

Public-health nursing has been established for years in Saanich, thus 
paving the new nurse's way into many of the homes, and eliminating the 
need of explaining the work and gaining the complete co-operation of 
the family. Also the generalized programme that each nurse carries 
on provides numerous opportunities of entry into the family. Often a 
home-school visit ends in a child-welfare or prenatal, and one leaves the 
family with the satisfied feeling of having accomplished much more than 
one hoped to. The work is increasingly interesting, for each successive 
visit to a family brings out new angles and new opportunities for instruc- 
tion that were missed before. 

H. Hillas, R.N., 

Saanich Health Centre. 



A DAY SPENT IN THE MENNONITE SETTLEMENT 

AT YARROW. 

Leaving Chilliwack for Yarrow, we drive through Sard-is, across the 
beautiful picturesque Vedder River, and ascend the Vedder Mountain. 
The mountain road is a scenic, although it is a very dangerous one in 
spots. After following the mountain road for about 8 miles, we come 
to a lookout spot on the highway, where we see below some one hundred 
of the queerest-looking huts and sheds clustered around in a sort of 
settlement. This is our first glimpse of the Mennonite Settlement at 
Yarrow. Descending from the mountain road, we dip down into the 
settlement. There is a splendid main thoroughfare winding through it. 

On the road we meet some of the Mennonite folk — the women wear- 
ing quaint shawls over their heads and long pinafores covering their 

45 



frocks; the men are mostly whiskered and are distinctly Russian in 
their features. 

We press on, looking for the school for our centre of approach to 
these people. Oh, there it is — a two-room school right in the heart of 
the settlement. 

We introduce ourselves to the principal and take our first glimpse 
of the pupils. The first thing that impresses us is the seriousness of the 
countenances of these little folk. They are quaint, respectful, little 
people, and watch us with sober grey eyes and with never a smile. 

Inspection of these two classes follows. The little girls are very 
neat. They wear plain little dresses covered with white pinafores. Their 
hair is parted in the middle and plaited in two braids. The majority 
of the boys are garbed like our own boys; a few, however, wear long 
tunics and short trousers (Russian). These lads seem to wear scads 
more underthings than we do, most of them being sewed into these. 
In regard to their physical make-up, we are amazed to see: — 

(1.) Such wonderful white teeth, so healthy-looking, too. 

(2.) Such huge tonsils, which with a cold infection I am sure would 
close the throat-passage. 

(3.) So much defective vision. 

We are not surprised, however, to find that there is a carelessness 
amongst some of the children in regard to cleanliness. This is due, 
largely, to inadequate bathing facilities in the homes. 

Thus we gather from this first inspection that there is a great field 
for correction of defects and preventive work. Having finished our first 
routine inspection, with a health talk to each class, we are invited by 
the primary teacher to listen to a song from her class. The Mennonite 
children love singing and are overjoyed to display their talent. Truly, 
they have beautiful voices, so expressive and so full of rhythm. 

We are about to leave the school when the principal rushes out to 
inform us that there is another class to be inspected. The overcrowded 
condition of the school, apparently, warranted the formation of another 
class, housed in the church about half a mile farther down the road. 

We find this class to have the same type of child. There are the 
same serious grey eyes watching curiously our every move. The teacher 
informs us that it is her first experience with these children, and that 
she is amazed to find them such keenly interested students. 

I note with regret that the children do not get enough relaxation. 
They attend school five days of the week. Saturday they have German 
school the whole day. Sunday they have Church and Sunday-school. 
The after-school hours are not leisure ones for these busy little folk, for 
they are employed in doing many chores. 

Having seen the school-children, now we are interested to see some 
of the homes. We find the leader of the settlement living in the largest 
house, and it is painted (there being only a few painted houses in the 
settlement — paint denoting riches or rank, we think). The leader is a 
well-educated man, who talks with a slight German accent. He informs 

46 



os where to find the babies and the cases he thinks that we should become 
acquainted with immediately. 

Now, most of the Mennonite women do not speak English very well. 
By the time a few visits have been made we find ourselves speaking broken 
English. The houses are mostly one- and two-room sheds with chicken- 
coops attached. They are usually surrounded by mud caused by climatic 
conditions. There is a lack of furniture and comforts, but, in spite of 
this, the floors are scrubbed clean and the furniture, although crude, is 
spotless. The mothers are very interested in their children and listen 
to our advice with the help of the child-interpreter. 

It is remarkable to find that this little settlement, situated amongst 
Canadians, still remains distinctly Russian in customs and manners, 
and would continue to do so for years if outside influence did not inter- 
fere. For example, in making home-school visits at Yarrow, not one 
door was opened for us by the occupants of the home — our knocks on the 
doors were greeted with a loud " Come in." 

Marion Torrence Card well, R.N., 

Municipality of ChiUkvack. 



THE OLD SULPHUR CANDLE. 

The early discoveries in bacteriology lead us to believe in the survival 
of disease-germs on places and things which had been in contact with the 
patient. The attempt to disinfect " fomites " has been one of the chief 
occupations and main avenues of expenditure of public-health authorities 
all over the world. 

With the progress made in bacteriology and epidemiology, we have 
learned that it is persons, not things, that are dangerous. It is the 
patient, the mild and missed cases, the convalescent, and the healthy 
carrier who constitute the source of the disease. It is they and their 
attendants who control or spread disease by their careful or careless 
technique. 

In view of the facts, first, that disease-producing micro-organisms 
are disseminated by the body-discharges, and, second, that most disease- 
producing bacteria are of a parasitic nature — they die quickly once 
outside the body of their host for lack of food, warmth, moisture, and 
darkness — terminal disinfection with no adequate care of the infective 
material or recently infected articles during the course of the disease 
is a fine example of locking the stable door after the horse has gone. 
By the time the Sanitary Inspector arrives with his sulphur and formalin, 
etc., the damage has already been done. Other persons have become ill 
and are known sources of infection, while still others mav have become 
carriers who are unknown sources of infection — constant sources of 
worry to those trying to control disease. 

With regard to the germ-killing power of disinfectants, it has been 
proved by experiments that to render harmless the sputum of tuberculosis 

47 



patients by means of a 5-per-cent. carbolic solution requires at least 
twenty-four hours. A LO-per-cent. formalin solution must be in contact 
with sputum for one hour. Now, then, is the casual swipe of a cloth 
wrung out of a Lysol solution or some equally smelly household standby 
going to kill the germs of disease? 

Fltigge, working experimentally, placed cultures of disease-producing 
germs on walls and (loot's. These surfaces were then rubbed with bread- 
crumbs and washed with a carbolic-acid solution. After this process, 
which was far more drastic than ordinary measures, many of the germs 
were found to have survived. 

An experiment which proved the inefflcacy of formalin fumigation 
was pel-formed by William Walcot. He placed diphtheria bacilli, strepto- 
cocci and staphylococci, on walls of a room, introduced a large quantity 
of formalin vapour, and then hermetically sealed it up. Culture-tubes 
inoculated from the walls after this procedure were found to be positive. 

Professor C. Chogas, Director-General of Public Hygiene in Brazil, 
who has written a monograph on "The Practice of Terminal Disinfec- 
tion,"' believes that terminal disinfection as practised by most countries 
41 is a procedure erroneously founded, almost always useless, and whose 
practical results bear no adequate relation to the labour and cost in- 
volved." 

Fortunately, institutions teaching health and organizations promot- 
ing health programmes on the North American Continent have realized 
the futility of the time honoured method of terminal disinfection. To-day, 
most public-health measures for the control of communicable disease are 
concent rated on the care and isolation (concurrent disinfection ) of the 
patient and carrier. 

Inexpensive, simple, effective, and easily practised methods are 
adopted by modern public-health authorities in their campaign against 
the spread of communicable disease. After carefully explaining to the 
parent or nurse the necessary procedure to protect the rest of the family 
and the community at large, we often find on a subsequent visit that 
many of the details have been forgotten. To offset this, we are now 
preparing, in the North Vancouver Health Unit, pamphlets outlining' the 
simple methods of technique necessary to confine the disease to the 
patient. These will be left in the patient's home by the Public Health 
Nurse after she has carefully explained the principles of isolation. 

N'OKAII l'i. ARMSTRONG; K.N., 

North Vancouver. 



SOME EXPERIENCES IN TUP, UNIVERSITY 
HEALTH SERVICE. 

The recent outbreak of smallpox in Vancouver has caused an influx 
of inquiries at the University Health Service from the population of the 
University and Endowmenl Lands regarding vaccination. 

The inquirers were many and varied, as were their reasons for seeing 
us — for, let it be whispered, these people were not by any means all 

•IS 



clamouring round our doors in order to be vaccinated. Indeed, we were 
deeply touched by the sense of duty which animated not a few of these 
visitors who had called for the express purpose of telling us what we 
ought to know, and did not, about vaccination and smallpox. Notwith- 
standing this seeming set-back to our plans, there are at the time of 
writing 1,050 persons at the University and in the vicinity who have 
been vaccinated since February 4th. The total vaccinations to date 
stand at 1,150; students never previously vaccinated numbered 160, and 
we are still vaccinating. About eighty of these vaccinations were per- 
formed by the family physicians. 

At the University Health Service the puncture method is used on 
the underside of the left arm (except in the case of left-handed persons, 
when the right arm is used) ; three punctures are inserted, one being 
used as a control. The vaccinated are generally required to report back 
on the second, fourth, sixth, and ninth days, and are advised to avoid 
all dressings and shields. Of six students who were vaccinated three 
times with an interval of ten days between each vaccination, four failed 
to show any reaction. The reason for such failure has not yet, so far 
as I know, been scientifically determined; there was no history of either 
a previous vaccination Or smallpox in the cases mentioned. 

For convenience I shall divide our clients into groups of five, thus : — 
(1.) Those never previously vaccinated. 

(2.) Those previously vaccinated unsuccessfully and since become 
" conscientious objectors."' 

(.*>.) Those successfully vaccinated at some time. 
(4.) "Conscientious objectors." 
(5.) Christian Scientists. 

The group referred to in a previous contribution to the Bulletin, 
those who passed through their school-years without being vaccinated, 
notwithstanding the fact of their parents not being objectors, but merely 
indifferent, were not in evidence this year. 

The first group, those never previously vaccinated, whose parents 
had been in a sense objectors, but who were now anxiously seeking advice, 
were given literature supplied by the Provincial Board of Health to study 
and discuss with their parents and instructed to report back. The 
response was very gratifying. 

The second group, those previously unsuccessfully vaccinated, were 
a little difficult; the idea being fairly general that, as they had not 
" taken " the vaccination, they must be immune. This belief was very 
hard to obliterate, particularly so in those students whose parents had 
had a similar experience before marriage; thus, they contended, im- 
munity has been inherited from my mother, who had never had a " take " 
nor an attack of smallpox. Whether or not an immune reaction had 
occurred when they were vaccinated was difficult to determine, since 
the scratch method, without a control, had almost invariably been used. 

The third group, which included those who had not been revacci- 
nated within the last seven years, were quickly and comfortably vacci- 
nated and dismissed with the usual instructions. 

49 



The fourth group of conscientious objectors may be divided into the 
" articulate " and the " inarticulate.'' The former, whose spontaneous 
and uninvited volubility regarding the ills produced by vaccination rather 
took us by surprise, failed to move us to response. This attitude on our 
part, although at first unpremeditated, was adopted because we noticed 
it generally had the effect of reducing the orator to silence in a very 
short time. This was important, as time was at a premium with us, 
since we were vaccinating at this period about 100 persons daily; and 
our office is very small, somewhat stuffy, and quite an unsuitable place 
in which to hold debates. However, the moment our adviser became 
silent we inquired the why of his presence at the office at such a busy 
time, and if we could be of service in any way — to which, the answer 
forthcoming was in effect that he or she wanted us to know that he or 
she absolutely and unconditionally refused to be vaccinated. At this 
point we sympathetically acquiesced and requested the name of the person 
or persons at the Health Service Office among our staff of " two " avIio 
had made such an erroneous suggestion. At this juncture we were 
generally being asked for advice, which was given with particular care; 
and, curiously enough, the advice was sometimes followed and certain 
of these students were vaccinated. I never can bear the silent reproach 
of their young eyes about the ninth day, and often wish that any one 
but me were the vaccinator; however, I console myself with the assur- 
ance that such a one will never contract smallpox. 

The inarticulate group were ready to give us evidence in black and 
white of the personal history of a relative or relatives who had been 
stricken down with smallpox, although they had been vaccinated or 
because of vaccination. One letter, which a student's mother, who lives 
in Kaslo, had requested her to place before us, reads in part: "My 
youngest sister died after it and your Aunt Edith was an invalid for 
many years; she was a nurse. I knew such a pretty little chap of 6 
years who was stone-deaf — vaccinated as an infant; abcesses came out 
all over and in his head with that result, and his Dad used to spend 
his time taking him to every expert for advice. I was vaccinated during 
a smallpox outbreak in England. What was put into me I don't know! 
I swelled up all down one side ; the odour was terrific. I could not 
get a strong enough disinfectant to make my vicinity pleasing. I had 
a running sore for months afterwards — a strange experience for me who 
always heal so swiftly. I think you Avill be safe if you keep a well- 
nourished and exercised body, and a mind intent upon doing your duty, 
happy and fearless." 

It is easy to understand the fear which is implanted in the hearts 
of these young people — even those who are over age and take matters 
into their own hands, requesting vaccination, are terrified during the 
moment of being vaccinated, and often faint with fear. The lady whose 
letter we have quoted is a Christian Scientist; it has not, however, been 
our experience that all Christian Scientists are necessarily anti-vaccina- 
tionists, and the reverse is probably true. 

50 



The fifth group included a number of Christian Scientists who were 
found to be non-combatant and really interested in knowing something 
of the scientific facts, albeit they were not particularly keen upon being 
vaccinated if there was a way out. We found good reasoning ability 
among these students, and it seemed to us that our efforts, not centred 
on persuading them to be vaccinated, but rather on the elucidation and 
interpretation for them, of the latest scientific findings on smallpox and 
vaccination as we understand them, and as given out by the best scientific 
brains of our time, were more than rewarded by the results achieved. 
Some of this group were vaccinated, because they grasped the facts cover- 
ing the general procedure followed by specific communicable diseases. 

Summary. — Public Health Nurses, I think, have an enormous respon- 
sibility in the elimination of unnecessary fear of vaccination by educa- 
tional methods. We should seize every opportunity and use every known 
means of giving the scientific explanation. Such confusion exists about 
vaccines generally that we should, when giving lectures or health talks, 
add something of vaccines and their uses, explaining the different diseases 
for which they are employed, with emphasis on the specificity of each. 
The difference between vaccination against smallpox which we advocate 
and the old method of inoculation with smallpox virus directly from 
person to person (now illegal) is well worth going into thoroughly. 
If it were only possible to enlighten teachers, our task would be compara- 
tively easy. There are too many unvaccinated teachers in the schools 
and something should be done about it. 

The importance of seeing the vaccinated person at intervals after 
the date of vaccination cannot be overestimated ; the follow-up shows the 
type of reaction, if any, and dressings when found should be removed. 
If it is a "take," advice should be given to the vaccinated not to use the 
arm unduly between the ninth and twelfth days; the importance of 
procuring a certificate bearing the date of vaccination and its reaction 
should be stressed. This will be more than ever important now, since 
the old scar (which has in the past been so large and lasting as to enable 
us to decide about a vaccination in cases when clients have not known 
whether or not they have been vaccinated against smallpox) will disap- 
pear with the use of the puncture method. The difference should be 
clearly explained, particularly to the previously vaccinated, between a 
vaccination which takes and that which fails to show any reaction; 
we advise such people, if tried three times unsuccessfully, that they are 
quite as liable to come down with smallpox if they are in contact with 
it as if no vaccination had been performed. The revaccination of those 
previously successfully vaccinated ought to show an immune reaction, 
and failure to get this reaction indicates that another trial should be 
made to see if the former vaccination is still protecting the body. 

In all probability the people who claim they have contracted small- 
pox, although vaccinated within the time-limit of seven years, are those 
who did not react to the vaccination. Our own experience among students 
who at any time give a history of smallpox is that not a single case has 

51 



come under our notice of one who had ever been vaccinated, either success- 
fully or unsuccessfully, against smallpox. 

Be this as it may, the fact of 160 primary vaccinations leaves us 
with a feeling that all is well with the world. 

Celia A. Lucas, R.N. 



FRENCH CREEK AND DISTRICT. 

Reading last year's Bulletin, I find that a complete resume of the 
work in French Creek and District has been given, and as it has been 
carried on in much the same way this year I will not repeat it. I might 
say that, with the extension of the work and the entrance of Qualicum 
Beach into the district, it became necessary to have another nurse, so 
with two nurses instead of one a much more intensive visiting programme 
has been made possible. 

We are endeavouring to develop each branch of the work as far as 
possible and already we have made great progress. Prenatal and obstet- 
rical work has responded particularly well, but we have not yet decided 
whether it is due to the fact that the staff has increased to two or 
whether it is just another result of the widespread depression. 

For the assistance and co-operation that has come to us from the 
Provincial Board of Health and our committee we give our sincere 
thanks, for we realize that without it the progress of the work would be 
at a standstill. 

Dorothy E. MacKexzie. 



HEALTH INSURANCE AND PUBLIC HEALTH. 

" I can't get the doctor, because I haven't any money and I already 
owe him a bill." How manv times are we, as Public Health Nurses, con- 
fronted with this story in our daily round? In nine cases out of ten 
this is the reason given by the average person for not getting medical 
advice at the appearance of the first symptoms of illness or physical 
defects. Thus it is the cause of the many difficulties which arise to 
prevent the carrying-out of a successful preventive campaign. 

In a critical period such as we are going through at present, where 
the byword is depression and practically every one is poverty-stricken, 
the Public Health Nurse finds herself helpless in a great many cases. 
Instead of being able to refer her cases to doctors, dentists, hospitals, 
or clinics, she can only give her advice and leave it to the people them- 
selves, and as most of these people have a certain sense of independence 
they will try to forget their symptoms rather than feel that they are 
imposing on the doctor, dentist, or hospital, as the case may be. The 
result is that these slight symptoms of disease or physical abnormalities 
soon develop into serious afflictions which not only risk lives, but have 
permanent defects. 

52 



To the Public Health Nurses, and particularly to those in the country 
districts, health insurance is the one great salvation. For example, they 
go to the schools, inspect the children, and what do they find? Enlarged 
tonsils, decayed teeth, defective vision, etc. Next they visit the parents 
in hopes that these defects can be remedied, but instead they get the 
same old story of hard times and no money. The result is not only that 
the resistance of these children is lowered, but they take the chance of 
developing diseases which will affect them permanently. What future 
have these children if they grow up without good health? 

This is the great problem that each Public Health Nurse has to 
battle with until we have some form of health insurance. Until that time 
we cannot begin to show the great possibilities of our work, but we carry 
on in the hopes that it will soon be a realization. 

Dorothy E. MacKenzie. 



PERSONALS. 



We regret that Miss Margaret Griffin is not able to contribute this 
year owing to a severe attack of " flu," which has laid her up for a couple 
of months. Miss Griffin has been a constant contributor to the Bulletin 
and has always given us something really worth while. 

Miss Winifred Green and Miss Hilda Peters resigned from their 
positions in Chilliwack last June. The work is now being ably directed 
by Miss Marion Cardwell and Miss Geraldine Homfray. 

Miss Hedwig Hillas and Miss Margaret Sutherland were appointed 
to the staff of the Saanich Health Centre. 

Miss A r elma Miller has opened a new district in connection with the 
Cowichan Health Centre at Yonbou. Miss Ledwina Servos resigned 
from the service in Duncan to assume an institutional position in her 
own training-school. Miss Heather Kilpatrick ami Miss Pyvie Young 
were appointed to the staff at this centre. 

An increase in the size of the French Creek District by the extension 
to Parksville and Qualicnm necessitated the appointment of another 
nurse. Miss Dorothy MacKenzie was made assistant to Miss Griffin. 

The vacancy left at Oliver when Miss G. M. Kitteringham was mar- 
ried has been filled by Miss Isabella Craig. 

Two new nurses were appointed to carry on the work in the Peace 
River District following the marriage of Miss A. M. Roberts. Miss M. 
Claxton, formerly supervisor of the Cowichan Health Centre, has charge 
of the district on the north side of the river, while Miss Nancy Dunn is 
on the south side. 

Miss Hettie Fawcett, who inaugurated the services in Mission ami 
Port Haney, was married last December. Miss Mary E. Grierson trans- 
ferred from Port Alberni, her position there being taken by Miss Helen 
Kelly, formerly of the Esquimalt District. Miss Olive lugs, who left 

53 



Westbank to join the Indian service a year ago, has been appointed to the 
Langford service. 

Miss Emily G. Allen has replaced Miss Audrey Payne at Lady smith. 

Miss Dorothea McDermott resigned from her position as School 
Nurse in Nanaimo to become Superintendent of the new Preventorium 
in Vancouver. Miss Eileen Carruthers is carrying on the work in 
Xanaimo now. 



VICTORIA, B.C. : 
rrinted by Charles F. Ban-field, Printer to the King's Most Excellent Majesty. 

1932. 



450-332-8594 



54 



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